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Home My WebLink AboutWTR2700450(7) W-450 TALBOT HILL PUMP STATION WTR-10 1 #8 Payr4I] �heej§ bm-p -(o Pump Sfay-/anJ BEGINNING OF FILE FILE TITLE �ys�a � 8 �xyRoLC SheefS I&OC...T.E.T O. 0 W- ...... TATEMENT OF COMPLIANCE --!!an. 10, 1979 —ArAsm-whitwgrth 12ayrol) 'rIark '7' 4= I L9 ,d Jan. 79 %cd m 0014 pm1-1 h.�* b,1 1-d 1M d"I'll 11 1� 111 In �h4f of..W Tri- State Con Vt7F "n4 TnC�f- .nd 1h.1 __Withholding 4LXjCA Tamea Medical Aid A-5ujaLm 111-NI I IT, %kY 'Dq 'In PIP011MAUS X EXCEPT t Arlene Whr t.Eorth Payroll Clerk ' ,., ^ty_ wceK il. For Week Job �j� Irt-ac ate AvenueuN.E. Inc. Project , - "� Payroll 19 No. 959 - IOB Avenue N.E. Project No. � No.�_ Ending '�..�-- r Bellevue, Washington 96004 Contract NO._�� 455-2570 Total Amount Check Total Amount Total rChA Oed. Paid o. i. S P T `F S S M W ,iours Rate Earned Other Earned W L %� ✓ 7Y d` s d ') : a // tij � 7. Jf4 7i / �. . L l 1. ZI 1 1 hereby comfy Ihel $0 Perron is w0 r .S Ctn o' P. •n,— ,. IE 45 in a cereciable rate c.a,'ncd m .' . iu..•i:4 ' o e:vl the w:;. C Provrstont eWicao{e to the w�go ta: d. TuT4LS ' + I♦-state construction, tnc, vro3eet r. r� . weeKiy For 959 - 108 Avenue N.E. Project No. �4 ! L y 7 Y ' _ Payroll Week lot Bellevue, Washington 98004 Contract No. 3 No. Ending_ - .' 19_ No.T 455-2570 ' Total Amount Total — al Amount Check Tj F1 S S I M T W Hours Rate Earned Other Earned W1H FICA Y. AA SPsed. Paid No. 4WII—L, .. r n • _/ - AV A/Y wf r' i pp t to-.n. r � 1� 17 ff. I ', �G�•1 iJ -. ).uT ) ' 1 �I ✓ r7 •]�i f. 1 ( ell 14 :le.w 1 � / /- Uf ILL a i TOTALS I `�'' f ' a U•' u..IxPANTNere OF zeros STATEMENT OF COMPLIANCE ee arD••nV wrrr_R • R.,aaar llrwarr Xe >.a'.-, 1)Thet I ,r suPn•', •M Dsemen[n' the wrsansared by 1 1 r �!� n<ol.... t anar• hxt dm,PY eM yyrnl!penvW c•xcwrne maPj;F_day�ol T IRWI .near �p a !S elt Deesnna emph.vM vn surd Dmlec: hove bsen Pi:�6y�rr�Ivtl ast<a Yweed,tMt rn rrEsxs love tzea o•wr.t M maae eyW.y dfrcnll ur rrWuecgy re or+n behal[nl nerd Jy�,_ /I--4 i.2.1 j _fort Ih!I WI w"kl,wspn eYmm Person that b, sns sod that m dedrscnonn new Leers made eirLneArtcsiv we rtxrpnsTr tjl ff...fM thou:sees eemud by .ny Pevaon-a her Q psrwfesible deeucttens sa def+ned rn Reealatw s, Pan 1 IN CPR if I fels A). tesued by the S.creran n!Labor under the CaPelan',A..t as smm.te.f Y Slal YY nl Slel IM c:/Slat e6C,'.6 Stet' iJer?. R+L S C ['ne). amd des,vMd br:cr: (2) Ttut any pamdls otnih%.rw rs. uvde.r:h.x cunrratt .egwrM r,;y .nnmred Y.r:pe ab+,vc P*rwd s,.o:mcl and r o�le+a, libel the rape tales for lAbmun �.msuhanma ean•eelrM Poemtn are not Its.lhan the aMhlabt. rase tares cnntewd m mY tree dote "y' mcorpwA+ed mtn 1M r nD.11; lhat m n e cbeunrnu•na a form themrn for oath IaMmr or mleMntc cory Inm•rnh the rarA he P o.f d. 11) Thoe am -111 bws r.-ti-plotcd m eM ic'e De,& d err doh Mvl%I r ll a..hone hde IVPmnluevnrp F•.repua:.-Irh , St.,e ap{,rtuhr eshID axxnry re<oYmsnd hy ;he Nv-au N Appmnoc.:..h-,P .nd Trn+unx Vntted A+.res Deyanmm• Y LaRnr II It no vueh rc,venwud agmev rX:atx s e 4•.tn are reem,ered rwtn rb•:Hv.v d Ap;rv.,±n e.RaP "Tnrmn, Vn„.1 St.,—Department of"W, rd) Thu: fat RNER/EFRINGE ILEREPITS ARE PAID Tb APPROVED PLANS. F'CVDS OR PR TRAMS Ier s.Mnl.m r.:t4 Wv.h-mrly..Nxe tetra p.,al•...vtih WM•o-�.. .aMm. Lxrn1 m+hw 11 10111",r:1 p.1 rIll Payments al fnnee b tflN es lra•ed m th, r,.:ntrwl hay.r .pprv....te pr..Snn:s for the IS,.yt t of a.ch emp;'vt wee. eac+•9• a>n,w m Section 4•-�h.l e tPi WRERE FRINGE IWNEFITS ARE PAID It CASII _ - Each UN,,, or mnTanrr I: led Ih It- almre eelrecnreC f•a,n.d: Rau Mw psld as rmli.al.d a- tM lmvmll. mourn r.�r loss mw the sum of the pphcahb Marc hvurlX wane me plos lbw a-+ant A rhw requlvd lnnxr Meahu as Larr:d In IM..nnua,t. v.lml as nnmd in wttlnn Iry t ,.. EV FPTIW EXCEPTION CRAFT_ EXPLANATION a — — _ I Farr w".3Y U R-De4 E voa fYIlmIMr 31 19n PLEASE READ ACCO[PANYING INSTRUCTIONS i4u Yrwe re rY..;.w b IR.P.L.9e.Yv,f«. I03. 104. ° MEFOR'.'COMPLETING ANY PART OF THIS FOR .w HIS;r.L.9.wr.TNIe 1.CA.1. LOCAL PUBLIC WORKS PAYROLL REPGRTIMG`•ORM gel9al NeNe. `-- rnNct LYMiw:Ic., of Too. Crrwb.9afrl PLEASE WRITE MURDERS LINK THIS. 123456 � 8gO PMIYT WITH&ALL POIMT PEN OR TYPE Y Uf ONLY leMN P°pleel Na ENPMer4 In No, Pn M1lw[eeY PnrNl NRApw We PNPeII E 'L"U Mr.a yew Lmr ,° I Pq a a,rhr.Pro' - PAGE 01 PROF$ Y .r O.M. uLEAYE DLANR r GrPls amount Groff ampppt Wpe4s ^ Occu^s- Pay A[Iue1 bmep on p Wer4a _ Soual sacunt OccuW PrY AC WaI Nmw on ony, a B Souel Srcunly po P rm hours Ur! 8 M D^er £S y y tron mpg hours Ut4 DroPct _ MUMper Drele[r - u !m- $$ y Numpar cDOr c.pe wor4ap !pr tnla r Dloyep i cope Cope WDr4w for this .& oloyw [i • Day D4nop D Pry Dpnc9 0 i A Y •rY �W p er !a n5 M J !y Y r !r N 40 pl a] r N J T 1{ 1 F 17 2 1B 9 - 19 4 s 20 z1 B — � z: z zI 1 24 -- zs 11•. 26 n u n 1T - 4 li u r! 90 IP %W`* Dn Year EMIgNe Intro rpe.r en.mPlnw n SAIL TO. OIY1.IolYeahoh Sy,lvn HIS WVIUS Ol9iSAW (Aeo4 onJ NeIN DATE M[NMD: I Era19Rl(DlnYP9rel AGaYINoObI Name Pt Perar PrpYinE B4Def1. i C Mior streM AplYn .,—_ U.S DeM AN BN .Boom B B Yorimbwor 1� mantmeO al ny'lt C.".SUN,ZIP I/q St.iE DonflMoY Av~,P r. Mee Gpre xYeper ----- uwNr 1 _ WMMMIYe,D.C.mzn TNeonYY No.N Ccmuct Ana Comr S Mum HP U.S.DEPARTMENT Oi LkbR STATEMENT OF COMPLIANCE e$r,�,°g1ra"atl 'pe aN na „n.�r.a„NINON • Beer—No U.RIOpt re Y ve b x>lo t�...,t 1 N rvr the patine.. I tt �� a� .TOT Y EWv t�ll ye W .— 1 av v1�( �P vorb 14�anE erAmp Ihtlac o �, Ia� „11 PerNm. empleyedor -aid pnV,y bay. been paid he full ayj,b wears a>med. Uu m,rebatesThave In of will M made.ghat duer,,or ha,,yfUV to or on behall of vatd T,• �lT/Lli Mine, l�j(�- fmq the f v wage.waned b ists weekly Y an n Y teon say,Ihe,he dadeAtbna hay. ctmN.n been minds either dateettY or Mann',Item the fNU wages earned by any Damp., "N',then peaNtaeibl.deduct......deflnM n ReRula'lons. Pan 3(29 CFR SUMitlt AI. .sued by the Serntop' of"bee-:.der the Copeland A t as amended (EN Stet WE 6A Sot 1011. 722 Sat 967,'o flat 359:40 U S C r(w). and devnbed bedew: , L��IY/,iis/ /� /y /Y�a�Ff A I /e R O///O i/ELYliOL J't'�'i1.f/n.) �In -L That env p.Yrolls Olhefwne under this.canna..repaand oo be a.bmnted for the abode pe,.d an,correct and complete, qa• the wage nees for laborarsm mecM1an:.a .um..Ed'h.trm are.1 leas than the Will.ble w.ge rate. rear.und r any weAe detem:inallen mrorpnmed rnr.tie romreea; that the claaatO...mne .1 forth therein I.,earn laborer Or ree.eaN,ton Irma w,th.he.odd he Perfo.med w;:1 aTh.,Any -Plepceah. li.l.d mobs eMve Damsd are dint mullo"ed n.Imnw Ode aPprenhceehtp Proglam re.pareftd Later,ar If er,sucM1 licp p apeacY rec Anised by the Bateau of AM-e,,,e.hrp and TratmnA. Ltnurd States Dayanme t,of States D,'r h io,of Lc Mrred.geney eaten m A State,are re,,enyred wan.he Burt.0 of A,pemticeahM and Training. United at That: (a) MWRE FRINGE R;NFFI `S ARE PAID TO APPROVED PLANS FV\DS.OR PROGRAMS 7. In a,Rlit>on to.be bank hourly wage rates paid to cash 10DOT".r m ecltaru, listed at the above referenced Par roil, paYmen A of fringe beetlita as listed m the cOetrar,have been or At, be m.&in eppiWnate Programs her the benefl of s u such emplavees, except ae.rated a S.con a(e)below WHERE FRINGE BENEFITS ARE PAID 1N .ASH Fach Labors, or mechanic listed in the above refterm-Ad PAYnD has been paid as onduta,nd on the p.ytoli, atria.,m,•If"'ban the sum.1 the applicant:haste hoerly wage rate Dias.he amount of the required Irtnee heneht.a.listed m the contract, Plept as n,.,ed m setthm A(c)below EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION R�� Y✓/yl�T'(��rt>.rTw. liQ ri�L (�.[sa[.a (��E{.[�f D . Fwrw RN-3gl$ P"n"as "l l.-intenT... it"' �rr[sonT.of p.cwwrs i 123456 � 890i aim oN■s■■ ■■i■ ■ ■■■■■ ■ ■■■■■m■■■s■■■■■■■■■■■■■■■ ■ ■ .N■■ ■ ©m ■ -Ns�■��m'�°ii=■■■■■ Elm■m■■m=soon■so■■o■■■■om■■■"■�i ■ ■■■_ ©i�1 ii=ii=■■nsi=ni��i = iiii'mom■�'sin11 non o 01111■11 o is iNno�u I IM■N!N■■■■■■■■■■mN■■■ ■ ■■o■m■■o■■l� on■■■■■■■■■■■■!■■ ■ mn■■■■ a an small mmosssmon�own OEM BIN 0` 1sonson 0 , ■�■■■•■mo®'■mmson��smommonmon 0 C�Nonson ■■■!■!■■■■■■■■�■■■■�■■■ ■• ■■■ ■■®■N■■■■■■■m■■■■■■■■ ■■ ■1s■mm■ns moss■■■ ■■■N■■■■■mom■■moong■ ■ ■■n s■©■o■sonssono■■■moss■■Illsomsoon mommamloom ■■■■ ■No■in sn MasonIEBm 0 monsommoso mass smommons me sill a r I Clossum moons I } i 11.f.09PARTMI.,of I.AIOM Fcer Atpeo,.J«.eX.NP wuP Pi vrnp. • STATEMENT OF COMPLIANCE' I ratr .1,Thu 1 p r t'7t and endma tnn d 'Wp' all person n c enploYld o d w'a(e\ Ted.!rear m mate(A.ve be.n nt will tw male ether dlnctll nr IMlnctly to rr on hrnalt I A M.wrr.+n. nn•an. Inm the full w.kll«ate,sand by..Pyllt.aM Inu been made ithel d,ryn,ly w,M:reclly from the full wPRea..rtnd by any person, plb.r th,,n permu\iMe dedncnaeu a\JetmW iq Rtcubt—II Pan I(Mr CFR SubN1e A), x.,,to by the Secretary of LAbnr under the Crpelurf Ao. . waM iM 5•at 9\R 61 Stat IOe. 72 Stitt 96:::6 SG: 357.40 V 5 C 37nr1./,.nd dnn,ii d belt«': s K ') Tn.T am pat w!(x u:nemvan urea«:Ni.ronnart requuea Pr roe tun,.nvd br the awvn period.re.:,rn.t+red T„mule te;..iibvy thV«aye no-,for.,w nrnoe me�n.mre non+wined Ihrn,n an not 1,>.than the h",n waYe urea cunanM many f" dIn Ihnelmn tmorpwalM iota the cwlnrh tMt tree r4a(ificumnx ut form tneren 6 r eANf bbonr or vu n.mc run Irtr.w„n th<«reek M parfnrmetl 1, That anY apprcntarel emplol ed in the-.bnv,penod um duly ro- sh•t.J,n a bun&bae(pprcnuewMP M.ir.m repu'enJ a 5tne appTenie ophiunAIn"Il l .xP,dniitl d pY Inhe Hum.0 ,.f AWn,,i,..ah, .red TranmR tinttM Seta,Dryrann en d Laerr n f tn+ n arc qu,red wl :n sr—Depanm<nt h•I L.bu- d !` n a n. h a Hwe.0 of Apt-. In e.htp wren Tt_.,nw Vne" o TnaO I.', INUERF.FRINGE UESEFITS ARE PAIII T APPRf)t'FD PLANS FUNDS.OR PROGRAMS —✓. In Mlpan rn Ine M+w Mudv wept mtn,p.,d la each r N u'1.b.per tne.hini, L,I'd to e\b. e refennr.^I pre...nnnr, of"'It"heliAlita .n liand rn the nn rntci pare been ar wdl be Tnn,to appntpriale p:;.E,rel•\br the ben,gr of wcn employ,_ -II—PI a.n:rted in 5e.I,m kby Arlo. In' NNERF FRtNGk.HENEFI:ES ARE.PAID IN CASH F.ch LAM,I,,—mech.nn quid in the ah,.e mfrrcnsed pq wlt h.n !urn paid a(.n.mount andwaretl.m. R,r pa.n,li. nol le,.Dun'fit nl 1Xe PPPhcaMo tw,le Mwh way, -.re pl..the kmougt a!the nRmnd rnnya 6ene(iU.n Durd in the I Intnct.except.a nw.d r,ee.l .n 414,bal+w I.i EXI`FIMOSS EXCEPTION lCRAf T. EXPLANATION /�irr��r/, �✓ear C'c� Pw«VN.IAE.vw .0 Rc,.ate++ae rowN el,¢ct>. n«oa n•e a'.•.or prcw eNa _ ur.e.nu.•Inaw r.. torwet a u» T•.............f.,....b r...P.L.•aMf. s....roY, rD., ,.•'. .<a.e..< Y PLEASE READ ACLbPPANYING INSTIU/CTRM'! ro—. r,I r...n,Tor,1,a.1, LOCAL PUBLIC WORKS PAYROLL RE►ORTING FORM e« BEFORE(ORPLETING ANY PART OF IRIS FORI rr,l.ct N«.: M!M lscRM:lCrb.N Tfw.C•«ry Aafn PL[Mt WRITS NYee[RS LIRE TMIY 1 23456 -78gO 2910T.[n*ILI /,fNN Ir,Ncl R,. Iwr,rp'.IRS 0.. -- rp Plow[.Wf/ Paw RfMW LW PaMI MUTT WITYI NLL MINT PER ON TFPEA I �� r f • i Eer r J M.. l -te.r r• IL IL IL.I:_ a ,• lopK..11.LEIAVE IL AMx PAGE 0• PAGES D ra+.n/Yount G,ms aPDun\ . Sacral Acniry OtcuDa' P.Y ACWb n .tlb Ra..• _ t W«HF- 71 NDwE.t bon Par •our. .....I, J'.v, e E Sot4r{,Wnry .an Pry AC\u/1 srna onrode Cod. W,rk" for C:n u•em u ..Der Dl�m ud :mb \borMc srlud 1•r Mi•Dar mnotl Dro," 6 0W J D 4 p L « or f➢ •. b fJ p of fr « b [1let ].,I" ! I 11 , A r i I, + ! TE 1 » + IS , i Il a i1 -LITTFI t TF T- n — Is — 11dn0i Oq rear I•Y«a lgw.w •rc•rYM«d q 0An MEPAA[e: I I (LT.cY«.) RN _ W l /0: CSkd.MIOr"im STSMS NrE Sark"DIYISIM Name of Rr.p Pnynw[R•Dat i twpr JeS MoG mmm a InIkR _,_ of Crry.fpp.zv R«R B415,RAY CIfamp.Bi[I. At.a C.M NMbr --- IAB•� G[[[IIYtk[Avesta.R W. ni[MON C,♦.w. ro'../ar/n,..�Canr•ct Arm Ce•.�_�Rppa - M[fRl[IeR.D.C.#J! __� t1.E.PEPaaTYEn%a%LA9�R - a•aa•Na-oun a,%•m- � • STATEMENT OF COMPLIANCE • ', , . . ,, .,. - 1 —• �P_� .1 That 1 oa a s,pyvd dlr var,•ene a Pe+'�.nx,- _-�fd!lflJ�n��-rw ur,m - ' -• JlL._ In,7arl endtPe th.. Js.a. p. 1 p MI /}� wales "d. that n.. rehatea na,.Open�.w,;:I.male xdUer @.aelb ar 1adOr,-b e. .r..n 1mnaD M. y • 4Mw&—&k=fmm.dM f WI weYi%wlea aloud fry an%PanaN and tha rw dMn; - .ve. been made edtMr d.rcct!v nr,eddrectlf from'ed w ww.named Dr an.pnraon, other thin Iurmua,Die dtdzdx.ne...drfinW In ReAwla%S do Pare 1 Qp CFR&ANNde A! "'"by the lrente%% If Labor role,xM t`oaria 1 A.t a%amenl,-n, 48 grad We n 1 Sdat IM. ']Seal w'. KA Sdat. 3e7•a0 L•S C 2.i ). and described b 1u— Ul„�ewC jE Fi�Ao r fir' _ IS m Thad a •-rwYs mM.wtse uM., ;e,x< •na rapu.r,y e. M _t.......I I_tnn atm,r P%rind a .,-ne.d anA.,. Inm. .0 ••� .aae u!ea fm LFa rvsor nNrhart¢s roSWxd tbrteu are and;e.S c 'Ne m weer deurmmat<.m ,ncnryorvnd ,mn •fie,..re.r..... .ha, fir, apA4n ante nwee rav, oanUced wr laSulm.n.ns v. (fifth three In fnr raeb lab.m ar mrcMm< e Irrrc w�tl.the work he peAva.•,ed xn 1 Tnat•nr aPrrc- cea explored n.ape aWre pv,..d are d.J, rea.an-rcJ m .N.n.!Ar app,enl„eehlP Vr:ee...:e..L�a•ered ul If apPrr,n.nh:r ademt rc, bms•d Dr 'be Hu:.. -:f A 1 sh labor, +vcn rcru A a crier ra;ap m a 5•atr art o- n.rc�m�� Iv aM Tra.nv,a C,1••d 81ama De,.n-m• e( B.•�ee newr•r-ael J La4n r ..... d u4ne Iswoae•+l Arl•.^:In. ��P n.l rr.umn,: nrweA AI Thad: Iq WHERE FRINGE RENEFITS ARE PAID TO APVWU%RD PLANS HINDS,OR PROCitARS In adArDaP t the thdo h. 11 h. :rt mr.harm lumd m dn.alnre,.levm....l pal I- Pagmemro ,f .,* Lrne Des ax 6.. m fir me,• Men Been ue wdi M mad• r+aprr 9......1 Ln the hen,W .,f rim#nmpd:a+es .0 not a%... m k.: +r.An,r i nelnw vrar.a ,b WHERE I RME RENEFITS ARE PAID IN CASH b:ach Lab,-er ur head m the t—'mkremW G4Yrn11 tun been PalA e% mtltured an the ".,it, 1uamnvel n,r. le Ss Ih•n:hr sum nl the app,,.bW bw,r n.rurlr wale hot,P,,, IM amn.m<A the.muwrcd'h,v weRa w 1144d do Ifw<onnart.rs,epr as nudnd m nrrur:n %a?nelaa PTIONS EXCEPTION CUFTI [)(PLANATION Fa..NN.34 man man ml ©■■I ! ■e ■■■ ■■ ■uN■ ■ ■N■m ■ ■■ ■i ■ NNN! ■ Nn■■■N Ef■■! CNEC'NNNNC■■■!■ ■ C` ■■ m NlCN ■! ECE■CN CCNI■N ■ ■■■ENli ' �■n! ■■IC■ ■I■NN■ �■ I■■N■Cm/ ■!■ LANCE■EINECi!■!N ■ NINE ■ nNE C■EIN■CENN■INCCNH ■ ■IH■!No■■ENNsn■NNN■■■■l-- ■ NMI IB- !■!■■I ■ ■ ■t! ■ ■ ■■®■LAIN■ ■ ■■C C■ on ■■ ■ ■■ H C Ci C■!!�i ■ ■C° ■ImIENlNl ■ ■lCHC■NCCNN ■ ■■CCCN ciCi E!E!I■ ■ E■iC!!N!N ■ -lIC ©■ENE■!ElN !!N!N■NNNNN■ ■ ■■■■I N 10 �'C:■■CCI■ ■■N■■!C ■ C■CC■nm ■C■EC!■E■ ■■■■ I■ ■■ C■CC MEN sign C CMIN i =N asa!■■■■ C ■ ■ CC■■� C■■ ■N■■s ■■■CNN■■■C■..!■■ ■ ,Ei■ ■.Cg•• ■■N■EC■ ■CNC�■■■ . ©■■ aNN■NNones C!lNNNNlC NECNC u.n:n[as PANTBEwT 0an1 LAG LABdB OTATEMENT OF COMPLIANCE • Awo MT 1.Pal .nrt �I1 Thai 1 p e s vn the patmm�e I the --pL,xea tv. ro � me tha he Pavm � persona non,d � U (BuLLda aea.b - m. ,.. P and ending N dad'>( all pl dos . .� been 1u'd��}�{{666a full —fin +' 6e(/f}/�M.that no nebatea haw.(been o,will 4 made.idy,dually or tnduenh't or on MhA(of �a ' •—t`y Ti�RZ;#4 ,I�feom the full vee4ly vase;earned he...p•r+mt+iul chat no deauctivns It.re bean made eLLher diraeH,ob hash.allT Inns,the I.0 wages ea mud by anv person.h,h.,than permuaihk deduetiau+a defined ,a ReRaladtoaa. Part 3(29 CFR Subtitle A), iawed by the Seeman of Labor under the Cup.land A.:,. as amended td8 An b48 63$tat 10h. 72 Stat %-,,76 Stat 357, W V S C ttfrc).aml dasenbed!Wow. ftU Jr Z*Zgc A2 KL Lo oc (1) That ant pat bulls ,Ihela as under thra:onlun eequlead to be xal,iced far the above perwd arc aunecl aml c�eapbte,Ina,Me vats rates(or is awersob mechanu'e<onumred themm are he, leer than the applcable v+ge rates contained rap detemts.wuan maurporar<d Into the eonBael; that the .atlmeunn'set fon% !hymns for s¢h labsee,11 mei,hamm�cum farm wi1h the work he"In'et l3) That anv apprentices emptetud in the above In"'ace dull mat'emd m a Eons fide apPmnticeshtp program le tared s,ttt a State apubenneeship yaetwv n nre•d by the Ht.maa nl Apprmocennlp aml Trawtng, United Sates Dep.mein of LiMI,ur pi no cA Law,xed agenry rxta m a Orate .re aro en•1,:pF'hs Humyu of Appmvt.wehep adA Tmm•na. UnueA 4tatea Depanmem M Gbor ,it Thai. ;s) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS FUNDS.OR PROGRAMS _se In addition n,-he has""hnarly wage ram ba s paid to,�ar t laer c.r ri-hant laud in the above referenced pav, all, Pgment' of(lease benefits as lutad to she.0 dwct have teen or will be made to appmpna'.ppgrana I.,the lewd ofsuch emf4u)ves. eacept ae noted it Se•ctnm J,a,below (b) "ERE FRINGE HENEFTT'S ARE PAID UN CASH -- Each Labn"e•t or meotantc listed In the above m4•enred pavmll has teen pald ya tndutated nit the paa'mll, en bn�ount .4 Iona than the sum ul the applicable t awc he:rly wage rote'Is the amnunl of the regmrad(rinse bene(ua as LsaW m the e>mr+at.except ae noted.n sr_uun f¢i Nlow EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION 'Eff!RIlsA•va�l, I�✓.Ue� �'CExK _ 1 ��c Zvz��.e..��_ I. • INSTRUCTIONS FOR PREPARATION OF STATEMENT OF COMPLIANCE This statement of compliance meets needs resulting from the amendment of tho Davis- Bacon Act to include fringe benefits provisions. Under this amended law, the contractor is required to pay fringe benefits as predetermined by the Department of Labor. in addi- tion to payment of the minimum rates. The contractor's obligation to pay fringe benefits may be met by pay rent of the fringes to the various plans, funds. or programs of by mak- ing these payments to the employees as cash in lieu of fringes. The contractor should shoo on the face of his payroll all monies Dail to the emplc•sees whether asbasic rates or as cash in lieu of fringes. The contractor shall represent in the statement of compliance that he is paying to others fringes required by the contract and not paid as cash in lieu of fringes. Detailed instructions follow: Contractors who pay all required fringe benefits: A. contractor who pays fringe benefits to approved flans, funds, or programs in amounts not less than were determined in the applicable wage decision of the Secretary of Labor shall continue to show on the face of his payroll the basic cash hourly rate and overtime rate paid to his employees. just as he has always done. Such a contractor shall check paragraph 4(a)of thestatement to indicate that he is also paying to approved plans, funds, or programs not less than the amount predetermined as fringe benefits for each craft. Any exception shall be noted in Section 4(c). Contractors who pav no fringe benefits: A contractor who pays no fringe benefits shall pay to the employee and insert in the straight time hourly rate column of his payroll an amount not less than the predetermined rate for each classification plus the amount of fringe benefits determined for each classi- fication in the applicable wage decision. Inasmuch as it is not necessary to pay time and a half on cash paid in lieu of fringes. the overtime rate shall be not less than the sum of the basic predetermined rate, plus the half time premium on the basic or regular rate plus the required cash in lieu of fringes at the straight time rate. To simplify computation of overtime, it is suggested that the straight time basic rate and cash in lieu of fringes be separately stated in the hourly rate column, thus S3.25 .40. In addition, the contractor shall check paragraph 4(b) of the statement to indicate that he is paving fringe benefits in c.. directly to his employees. Any exceptions shall be noted in Section 4(c) Use of Section 4(c). Exceptions Any contractor who is making payment to approved plans. funds, or programs in amounts less than the wage determination requires is obliged to pay the deficinecy directly to the employees as cash in Feu of fringes. Any exceptions to Section 4(a) or Seb). whichever the contractor may checx. shall be entered in Section 4(c). Enter in the Exception column the craft, and enter in the Explanation column the hourly amount paid the employees as cash in lieuof fringes,and the hourly amount paid to plans. funds, or programs as fringes. bs the s.eennwm.nt of naru ..U-s.eo nr rnmmx on.. w eri,knyron.ox M04 Kitt i2.76 pee pW of IN 14—k Numbrrm.-w n ti-o CMdox Number 1.r1 FORM WN-W • IMPROVE ., LOCAL PUBLIC WORKS PAYROLL REPORTING FORM �■ ■■ ■ on 0 ■n/fie■■/■s ■■ ■ ■■mn INNS!■ss ■a ■ ■son/ ■o ■ ■ on ll.moll ulmo MEN MEMNON mossommsm WE mass ESN soon�me��man RON n�� ■®sNisamlls�moons ��3 1 0■� a�� monsoon sons ■oo■■osno ■/■ ®■ so■n■■s■■on■ 1/■ ■ ■ ■n�■■■ ma■n�l�■�■■■li■nos■■sn ■ ■ s■� ■�■■■!■■■■■■■■ �■■ �■ ■ man on Eons n■ ■■■■■■s■o■■ns ■ ■■■s■ ■ Woos/■■■n■■s■s ■n■ ■ ■ ■a■■■no nommonsNoNS 00110011 milli ■■=/moon■=soon ■i'i■ ■©■■■!■!■ ■■■iTii■ ■ _ ■■■ ■=s=s■ m■s■ ��ss■■■■■■Nss■n■ s�■■ ■mo■mmNmm■■■/■m■�■�■�o■■ m =N■■■/ i U.S,IHEPA*TWlDnl OF LABOR • STATEMENT OF COMPLIANCE e,-Aa.�at.J"�x„ uslwF r+sa axo I.auw wve•Pn 1 �/Hie // ors' _—�N��(� . ,, ,..•. rr I�T.�n//at�'1 ep - nfParmeer ,1 rn.ce.>•�.a arro /!'��f��d�. '1jy r „� X and etdma thP(ZMy of Ip atl On, Ul.n It 1 fuH •M n,re1eare .e S!!n or Fill ba mndf rather d"!L.,•er Indimdlr 1,. .x / -„tmnait ul w+0 •« ! .... . �y r feJO tM fw:..my FALM HIMq by am p1..and In.,rMl dedYCilOu elve nee,.mad!!rA<r dl mc•Ir ar Ind fret,1, 1row qi,fnD wages named try wnl'Feraon. .,M,tide ylrm.aer9Fe dtdwtrawn u daCmed in Regulauona, Part 3;A CFR S"1111r A3, csaaed +r fhe 5 lnttwq of Labpr und'the Cg Ftand Ae A+ammdml I V R.1 "b h3 Sint IfFb. 72 Sbl•Jnn-. pe'Pint 'iii,W F1 5 , .270 a , no ng fi,'t,M4 nelor 121 That anv[mFr.tlx ..Ihervlsn Nu•1e1 cMa avnln•: mpwnd b wMx^•d(or the FI..w.e'sKradf am a. .M• .p:ete •hat the raA mrex(ur Nbom" '.pna ". nn,.. twd Ihnmrn a ItaJ than,,h appf.nw ble .aye rails Y n e,cm In J i'll11hfli rmuue tnlarpolatN Info Ine a.nmaa,1. Inel Me cOasdnu.uans del LqA themm fur esn blF•'. r me<lunn. c hIm wtlh rb!w,.A M1e perfnAla•0 nn :3. Tnal am appmnt"a f^.Ylurfd le 1h1.JMve penal JIe dYI. n'e111em4 In a O,n.11do.Vyrcnn•'esnlP I.r ,(ran(,W—d +nA • SMe aPpenace+Mp q;ep:3 v<ryweatq Ur :he Ilume� al Aype,.aa•'+hry ma TruwnL l'mrM S!.•,•.DeV+n..m• �f Lannr,or J no uuh a,zvanued aAfncr tnxfx m•5•rx .m rlyrvv4-i+rt .M•Eluru .f Api_••.•..hry`ar':?..m•ee U..1t4 spies Department of Later al Thal: iOf WHFHE FRINGE BENEFIT.ARE PAID TO APFNOVKD FLANS FINDS OR PROGRAMS In aMu,"e ro Ilte b+.,, h".11, wad• rmex dw W 1_ a�.•� me Hann L x..m the+bn.w•fen naed P•v r.�11 Pwv"•meta n1 I.".to Ia, as ❑.ttd m 11%, nrm.•�n nrUlen o w,tlxnt m.dr to in p "N.pe.Rrass her rM trcmflr nl aupb—Plureex eueyl Js n.iM in Senrm Vilc,below IM •AIIF.RF. "INGF.BF.'NEFITS ARE PAID IN CASH F.v.-h LlMrt• ar rrch.nlr Iu1M m Ine atwve tlllrenced W>roil h.. _n Wta FA rrc4cM4 en the Pavroq. .1 W.than the aura�•1 the wPPlkalde ha-atc MurFr Naga n!a Pluv the ame.mt M thr rryulled binp bineSta aw bAmq In Ila,-cnnhaa 1, vrfPl Aa n<rted m x!(rlun 4,,1.W FPTIO.N.S F%[l PTION(CRAFTI FMPLANATION ..,._ -_. 14 �-�fbl{�!Qielf/, ��f47f1L�EXK- �Lf�.�..u�s4lF>J7� Follow"ii�iN 'i�'i'�iim■ 'iiii�i onn""'iNJson 9 - 0 © ■ 5 , ■.■ N■ . U ■■ Sims ■s..■■ ■ �i�io'. ■H. ■ ■ ■ ■ �■�■■■i.■■./■f1. ■ ■■ii�■■�■n�i■■■H ■�Nunn !.. i . �so H!.!■.■■■H■■..■■ ■ ■� ■.■■■■■�■..!!!�■■"■■■ ■■■ no ■ ��.■0 lrmossommon mill loon I I liengs IL .� al monarom 0 Mrs so RE on on I mom I on Is @mliinus Ion low = ' � ■ ■■...■MOORE I' ii'i !� ■ �■i'ii■''■■'i_�■'■iminaonii 'iiiiiii■ a ' son assommossamonsoniON n i i 0 ■■m..■=■■■■ ■■■ ■l oil mom °i■ � I i' � � ■ : ■m ' n � H■■m■o■■■ n loom■. i. ■■■nnn■. ■_ sign . ■■■.■■■■ns ■ ■ �, O.L O[arARTYRNT or IASON ..6.ANP.Rua um.Pw •STATEMENT OF COMPLIANCE • �„ +, u.., Dole 1 Tha:I I r scM... ehrPre 4L ly7j mtl endma Me da)rwf lu7l fRrsons em,Pluved sn •a,d Pale, he,. ben. T full nod. tha:n• nmuex w he',evrer. : ,ll he maoe R ettoer d: Ptl) or,Miremie m er en hehall of... .lrirt GUrilnFci�ne,� r, C .. «.;a,�,,.tRr—a r • n•m the fWl weekly wages earned be any pen to aM:hat rw deJu,��. „ pave hewn mwW e,�hee Mwr:tr or"et"ay le"',the full w.gea earne •w s M 11 d roe,Mr.,. offer,Nan'.ee'..ihte daduclum as defined Re eWat,e Part 3 :Y CFR Sandrte A). mood he tM SooRun of Labor undm the CenelanI A.r as om-1 4 ,a Sot Oah A t Ste, 10[. 12 Sue %. !p 4!N a5'.,d0 1,s C Ybcl. .vd dray raped below- 12) Teat or,P•f rolls.thorn,.,wader rh,.conv.rr repuleed,e 1»sabmr!,re for the shone Penod.R come.,aed romP3ete,Mat Ole wen ralaa fo,I.boeenor see M1am•v coeatrW Mmetel are mn Ieev. Mo.the apPh::ahle rage rates '.."el I. am"W detarmPnt ul me orpue®ed Il:o rh. ,mnm„het the cL+nfir.,mws art conk Mem,n foe each I.boRr w meehauc con mpo«rah the sat he pe"." -n,i• Tbah.n aq•ennren o,np-"4,n the eW'e Pend.I. S I. Rytsten•J,n a tnna f:ce appronr,rPnn,p prapr.m ereietercd. SIAte .pr•n:.v,r..h,p [.:,cv «,•,gn,zed by :he H.,o of Appnn•i.rxn,p .nd Truno:e, U..,ed SMtes DryanmaN.i Lel•nr.or f m sorb Rr..u„zed aim.♦ vnH•ve a 5utc. .re me Re, el.oh hha Hureau,•1 A;pR-h...y,P and Tn.,.me. U.,md St.,ve Ooge,"' t al Lahr hL The,: I" REIERE FRINGE BENEFIT'ARE PAID TO APPR6VEP PLANS FUNDS.OR PROCrRARS In addd,ur •o the lw.,r houde vase.here pouf:' ,-oh lat ne.er hem„tired-II the.have.We.ncld P.q Pab lo'"eena of IPnae beneirls as haled In Wr � aer-nn4act hove hear,a %dl oe made I.•appn.pno:e peoyr.ms doe the l'enef,I of sueh employees. a Pept oe mt. • of Sett Van N,1 belay (b) "'V'RF,FRIWIS HENRET"ARE PAID IN C ASH -_ V.rp La Soo m.ehana Ireted in the stow nfe.tol P•am11 has teen p.W.a• mdmated ran the pasmll. anmmn a . ,raw IPonehan the six.of the applicable p.a,e h.urty waao rare Puts the amount of the requamd him;e ton fn• • Irand ttr contra.. nat•pt as notrp:n settmn ifc)bale. h.h Exc KF'"O%s [MCEPTION(CRAFT] Ek PLM*TION E, 1Elr.'�.loaerx! ;a1��4'L�L6'C.C1 � per.wN-0dE.veu LOCAL PUBLIC WORKS PAVROLL REPORTING FOft �® PAGE OF PAGEY"j 1 /23456 -7890 �W �_ o ■■■■gs ■lloI ■o ■■■■ ■mu■gnm■n ■usum■n N■on Doan ■ goon■■■ n■!■ ■In!!! anNm!! ■ so■l■ss■ ■on loss I NONE ©mosimlaanlnaaaaa■sun 0 Y■aa�aaoi�ia �aaaaai■aiaalagu■n!! is a■iaan ■ mlnm e■■ ■ ■■■■mans ■■■non ■ ■■ missana ■ a� ■ ■ goo=■ ila!l ai■! ■■ii ! ■aaia■ aa cimni = ani am ■■ ■■ mmn ME oo■mons■omon■■s n won Noun ■ ■■■■■ aHalaaain ! n■= n■ monoin oil =mn � ■aagw- mon nwssmg iiiis uia! ® ■ ■■ summons ■ ■■■ ■ an ■ Naomi maa=OEmos . ossom© aaaiaialaallo!!■ ■■! a moua NEN a ■ Isms ■■n� U.S.DEPARTNCNT or Lawt1 • Ewrti Agvooea wags•wo xou.pwtwo« STATEMENT OF COMPLIANCE • xaao�Rove..N. 11 RIOU Dv t ,x•m•. •�nwmry van, t de hvnhe Ante: (U Tool I P t "Per e the Paym,m a th.{na..nx �.(il.g ed hr�� a _ }` Use __•/ P 1 dnG m ri fin,. ne 1.11,11 peod rwmm�ni da...r�J 1 {IyM tv wl we IPr and endtn8 eh1erd.yar f 1h,1f .11 Wraons amldovt•d on said prol[rt twee bawn pal he full wa.ae/f/,E1.mjad, that so rebates have been or will be made titter 4rwctIv oe tMlnotlY too on behalf of a.ta y ` t�at.. YTm� fmm the full wwh1Y w.((es e.mM by am Wnnn atN fiat W deducnone have Zile been made.Noe,dueopY or nd,v,tI, from ma Fall wawa e.n,ed by any W. , ether Ihm penmaoible dedacsrout As diluted oo Neyulnteno. Pert d(pt CFR Subtitle Al. usted by the Secretan of"her under the Co,wisvf Act,as amended (48 Slat o48 rid slat 108, -2 Stal W',, fit ilal .Ict; Ju tl 8 C 2'bc),and deacnDtd below: ly�79'C/L_Q�D r��,�yrat �PLfi � r. (2) That any Wymlls othaewtxe unit.,this cemr." nyuired to he .ulesuved for the abuve W,ted are coma and cooplan; that the wags ores for I.bomE or mechotxcx cmtAtned therein are not less than the AlWlwalde wage rate. Cotmubwrl In my wags del-nalnanm In,nrpx.leel .to the e.ntncr: that the clwoAlotinna set fanh there,.for eso labour or me<MtnC Co. form x'tm the wor he performed (]I TMt aby aPPrcnbce.em.Plpyed In the above Penod are dull, rensrcred to a bona fide apprenticeship p,.gtam b,,%o,red with it state apprennc<sMp .'sn" ncaanued hY the Bunts. al Appm Mmeahtp and Trammy, purled Shm.D.Panmrnl of Labor,or if tin luoh— armed agency exwn in A$,.Is are registered with the Plateau of Appw•ort,eship and Trcinmg. UnimA Snte.Depanine nt.1 Labor (a) That (q WHERL FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS,OR PROGRARS lie In.miu.n to Ater boavl hou,!y-.µe ram.gold to veto lehnrcr or mechame lured In the ab.re re(t• rnced pit ,tip. PaYmenfs o1 Inge btnefns as Laud m the tomtit,have be.n,n will by made w appmpn.or Pmgratu. for the benefit a such employees. except as n,lbd in Section itct below (b) WHERE rRINGE BENEFITS ARE.PAID IN CASI4 �1 Ern Lahore,or echwc Lated,n she above referenced Wyrolf hat hewn P.,d A.,nit le.tad on the Payrvif. an amount not less thou the 1um 11 the.pPlicabli,ha.,c hourly wage rate Plus the amoant of the re"oned benefits as Land in the contract.except as noted in sen«m J(ri below 1c1 tXCEPTIONS EXCEPTION(CRAFTI EXPLANATION Fan WH-W"Ira, c tic«s. *ma tow.,noC ore =..,. a. ..., ..oz_.•C•. . O.M.B.M.E1R-T9K E xa PsamOw A 19]9 .owu[OJY U S.CFIInTYCNt pI COYYCIK[ Th..n1 •.rrM.n.N q 1—,P.L.!6369.M[..IOI. IN, PLEASE READ ACCOMPANYING lNSTRDCTRAIS a„/xs.a.L.9/./0,T[rla 1,CU.I. LOCAL PUBLIC WORKS PAYROLL REPORTING FORM BEFORE COMPLETING ANY PART OF THIS FORA ProNn Nr%: PryM L"I.:(CIH.or Tan,Cara[Y,NNN PLEASE WAIT[RMIBERS LIKE ME 1234567890 Y .VPS"Ll fabxl Pr.Wf Ma. E.~"IRS Ma. Pq Paw EaeN 110PRIMUT MY"WALL POINT PEN OK"PE44 ' I .-{vouYx•Ir le.n.,i ani i�w Lon `AGE OF PAGES OrF.rwl.e LEAVE BLANK --- GrON am Lmt P' c.N aaeUrl\ Seu>I sec.'d' Occu„> Peg Aclual NAee $ ¢¢ Ne<[a _ pcceea Pa ACWai ante on •taaR N.M., Iron Parr. ewrr5 An Dmpc[ 1. E, Drar. fi p SocW Security [ion no0 h.ra IN.Orelecr _ — 4 $9 urns MamOar coat c.ee woreee ter Ara S$ COEe CaJ[ WOM1b ter Ail onem� M s 0aY oenon E iE Dxyea R g� D[Y M'�ee S DIOYaE £ i J l) q q !1 N [e •1 6[ O! b J 1) Y 1. el a/ -- b •r 11 .! N �11 S2 2 19 A S x S 21 ? 22 � ?7 9 11 1 1 1 1 21 25 • 11 is 12 21 ll x 11 a is 90 affi 9 — MaIA pay Yew IgNa'xtb abra[�!ariabYb by .An►IwulB: [LTr.n Nn Ma„a BAIL TO: OiN,bkrw**SYeNm W SP vk<s DiriehR Max d hnm Prb>.,ne Raean r_.-.tCWrL'Mw ELPNIVc immkom RI AOmWs Mien stxd Abwaa_ U.S.DpwbMl M CeNrrce -',SYCbNMm gMrrb al n►rl Cih.SM M%.ZIP RA 0415,Ray C•-Smoce owl. Arne Caee Mlalaler WntM 149 St.MM CegBMIM ATeMN,MAP. nLaFNME: Tal[Mxna Me.of Carton Aro CeeSs Mlaaew - Re9Aw4m.D.C.am mae....ma.onq.ar. 1►►MOARTUENT OF L410M 4:e AWert.er .at AND..%. EMENT OF COMPLIANCE • ; .I,e�a»w N:, wgen 11.te y LQ_l�j�__ /+ 1 !/,�Trbtnv acc. LLEelc •1� 7-11)yTf�^ul,l�paY� r/v�fE�. ru IM ^P.V M nl tin,Mratn. _/Qf m. J_"_ .'fir mee aur,n pe r 1.j70L. _I_ie�-C-10_w loZ and eadln¢th .Y u( WL✓ 10-M .11 psrwnx emPWved ae run ; ..,e b.•... .m T .. metl (M( brae-havf Men a vela M adr mlher dlrenly t nr Wuxliv n Iroh v !f r t< Jd/-_ s�u� � Ivy Irom t/rc fWl«ertly wiles hrlmed hY anY p+n m and Ih.t Iw de f.. ...• Laell made either rlireclly ar n.6i.111 Irom Me III$«apex e.nd by any Person o01ar Nm fNlveraslWa gad.cltJm c.def(nM u ReRYbllYaa, P.R 3(A CPR SUHt(le A). Iwued b1' the 4caury e(L.W, Ynder the GepNand Aut ea a^endel ;qE SlN n.p n.l Atal IM. T.Si., Yby, `h s.t 157,40 P 3 CC 276c 1. and doe.nbed Minw: rF/Li'i. R p A��~We Pi lf�.a Cif l 2l Th.t M1 D.t r'll. ,:ner«Ise Balder(has convac( WRYIIed 11 M 1 dmDad(:,I the .Move DertJd an c0lRCI arld rampkW� !h.I the..Al, idea fur la:nrerror mrehanuea<on4tnvg Ihenln am«d Ica.than the appllcabA «aP ratrs a.mblaed m env «.pe mrJNomrd Inte the eonvscq rha( the:LawYnalron.xtl(onh Ihfrom for each lah•m nr meuMnv c fnm .Ith Nf «urt he performed on f 0 Th.t any.ppnm On es fmtdoYeq In MI above"MW are du!Y ro¢nlend�a.b,na I.de.pP,M1 a pmpran.epuromq arth s Swt .pPrentkrenhlP .pemY rr.ortnued by the D.reau I AWMwl,vnn µ+ ami Tmjnmp L'm1, 1•e Oep.rlmenl .1 Lahr,or 1 n. Yct recoRnued apencv nvut. m a Suee, . rv¢nured Adh•hr Rmeaa ,f AYR ,l.rnhr Tr. -ng. Cnund sat e Department of I-M.r 1 111 That: :.1 RHk:RF FRIFGF DEVEF'ITS ARE PAID TO APPROVED PLANS, FUND&.OR PROGRAM In add,bnn Iv IM bnn1. hoYAY.'a¢o nlen paid to r.rh IaWror.n mnfiw. lu ied m the.hrvr mRreo,:rd p.v rnll. P+vmrotn of fxnpe bane(ltY a. L-ted m Iho r.,ntwa here Men Yr ql M mAdr m.WrvPgals¢••allrama fur the Mxeq ul sucM1 envpinYeea. vuepl as nmvd to Sectl.m @t 1 bebR. (b) WHF RE FRINGE DEYEFITS ARE PAID IN CASH EaeM1 L.birf.nr mena.nac Itsud In the -W—rofero-need Pavr+ll Ma hyan.Pald w mdlc.lml .n Ilia "yrult. n amYuvl a,nt lea.th.n the sum-f the spphc.bly Wvm hawk «.ty ute pill.Rr...mum of the roRYlred pipve Mne(ne vs loud m(he rtMiwq. ru ror na a.,ad m nerbnn Nct t«lu« • � L:Yc EPT1095 EXCEPTION ICRAFTI .,� EXPLANATION J 'JM.N, .A R�TNK C w)IMcerml)1 lf!f *-[D>r c e..D.nubs N a.��r[«r or4 i... .;e. PLEASE R.AD ACCOMPANYING IN)TRUC2RINS Ton.nd.rr r.lui.rrW b yw,P.L. I'M.111.101. M. BEFORE Q)RMEIMG ANY PART Up THIS POR .rd lo):P.L.Ti..o.rwl.4 u.I. LOCAL PUBLIC WORKS PAYROLL REPORTING FORM /rNed1 Nr: PINedt L.O. tCly.r T..CnrN.L)wl PL[AU WRIT[NA ISM UAL TNt) 12345678gO VT USE L fedwal Prood A. [.~..M N., Pq lawM Ended Pgw11 Norew L){1 PIPM.l PRNIT[ITN WALL PANT TEN OR TTPE 14 iI Alir _ cgqwreq i..nrl.rrr( La., PAGE CF PAGES fd w GrA*—v*LEAVE•L mx Gm.MNMt GmU)w ah {{ )nClil HCVINI D[CVD)- PIY ACILLI Nr1rN M YI!\{ DCCVDi' •iY A<Wil .LI11Ld M NNFf q N.rD>r bM h ' Moo Pu Me1e01 art,. UM nN Aedn ter.PI.I.ct ii ca0e CDN Nnr4e0 D, �U snrn 3' 9 NumOer cN. :oN wdr4.d lot"I N F6YN 0Lv IIN ,.'ad j g !! D)[NneO N E x • � rW 3 « s .> .i w 11 e. r r i ed ed .I v nd nd {r a. N )1 er o r i t 16 17 2 11 3 b 7 i! n S i1 q 23 11 2i 11 27 I3 TTT n 1s - [1[ 2! >. IAwE1 LE qr wav,e) ,vw LOdre in"whavaa of � T0: Chief.YIMIm[ti[[31IYN:and kwhows OMWO A00w)shecs\Nintsl Cip,)uw,21T` iNA SI.✓✓WUNRi1R ANRr,N.N. TId,VNON[: ['Wile! TM1p1wu N.,0 Con w Area Cis��NI.O.) :'� NEEREIIYr B.G S� 5TANDARD FOKM :5 Yrvt-t ue Perica _-- rghTM.l LAPLUr� (Nonin. rear) (Aug. 1Dept UTILIZATION NIPONT MAY pnoer/►N of No Dept. or {�por IortLrl I... ...one Jar Yutrrtt no) MAY /77I This report to required 6y 6secutive Oraer 112.6, Ssctiut. 203. failure to report tso result to senttlone which include ruspen510u, tominetlon, Centel 4tfons or de Dorment To[ (esae Mae IaNtiN at teapil&noe seNgl Froe[ (Moue erW leostion of sontraoter) Civil Rights Division Tri-State Construction, Inc. Economic Development Admin strat_ijr. 959 - lOb Avenue N.E. 1700 Weatlake Avenue Bellevue, Washington 98004 Seattle, Washington 96109 •'ity of Renton £DA Project No. - <, Protect escription: r•:� 1 3. � } 5 einc. Total ot&I Yore Nour& of teployeent IY•• f..otrotel rEtr nuopoe uabor Closet e- e. • WA of of of ftu. Ias. •r• ot&n/ .otel to tot etmrit Eepyr coeFnQ4 Ws (I.D.) Tneo done Tot& Ylese Denie 'neion h M. o- raD1oJ� u& Island le Tri-State eonstr- o uction, Inc. pr_„ T 0 S�n 'e T, r rir � )r.v, rTr AD SA" / Tr AD T A C T f 1 r rr Tr ,dp ry ffr[e[e t :eM ur. en ate 9lesa •spAone Yueesr (Ine1u4e ArN Codo! �,, ��UNE 5,19'lA (206) 455-257C' CITY OF RENTON EDA-LPN PROGRAM MINORITY BUSINESS ENTERPRISE UTILICATION REPORT '(_ 4ON7N/YEAR FM/M- Pro)ect a EDA/LPW 07-51-23908 Title Talbot Hill Pump Station Contract W-450 (CAG • _) Prime Contractor _Tri-State Construction, Iix. Minimum Doilar Amount Allocated - S '4,j c)q$.� of Contract) Minority Enterprise Sue B Address Type of Work 'mount Paid i IRS Number This Month Ai-u Pniad+n2s !:CW.,cuo � T U P +"O PNNT"NIJ �►iNT/NV 2a22S.vo 12SO? NC. 12kO' A. KICV-L^." , ✓A6J gFo3� i l-ocl s8319 I I i i i I / Subtotal This Report S 2 ZZS,L `Chi !"07 Amount Paid - Prior Reports $ (�a52-Z. JJ Combined Total Payments S 19,749 .00 ( �) / i& Percentage of contract) Prepared B, Arlene Whitworth Date: J&Ajr-.f. 11,7/ Title: _._ Pavroll Clerk 401 Tri-State Construction, ALL FEDERALLY INVOLVED CONTRACTS OF THElnc. IN AREA OF Renton TOME udN PUN FOR MON11M OF MAY /9ls °"PRn� l Southwest Washington GOVERNMENT AGENCY CONRACT NUMBER LOCATION $AMOUNT 1 COMPLETED PROJECTED COMPLETION DATE Economic Development EDA/LPW Talbot Hill Purp 214,489.00 /00010 October, 1978� Administration 07-51-23908 Station • ALL NON-PEDfAAL CONTRACTS (A4ARDED SUBSEQUENT TO MA-ASSISTED CONTRACT) IN PLAN AREA FOR ABOVE MONTH "NM£"OF CONTRACT CONTRACT NUMBER LOCATION $ AMOLUIT x COMPLETED PROJECTED COMPLETION DATE AMAJE i ud,D"AATV9NT Of LABOR fcen AWw, e .14. .Rp....orv.no. • STATEMENT OF COMPLIANCE • xAnn..au...0 AI Big., Aiw ji,qL 7� �+. — l U/Nfi1Ue[TN —._-_Ce'_'SY�a r a oAre M.F,erchv N we m a.ma n rmfl I i 11 Thal 1 pay n a the s paymCnt ni the INrnonc .-.1 Ly TALag thr i uJ . R _:tha, mr ..cmll Peri••d anmmencmR on Mr i`a�roeif Mw '•n.. 14M and entlmR Me y May_ 1 Veranne pmployed un card prelen have , n pald Mh full weekly 'eKl. ed.Mu no rebaMe�a been er x,!;\+.atle ether ditt<tly'ee iMircrtly to oe on M-h.l!of.a,d T,- f om the Wl weekly he....NrtttW by Any P,R,.aced tMt eq deductlOOc Aaf! been mAda other mm tcHY n dc (bl tly leotA IRA l waRer p..d by Any Poe..A, eWe an t th "missttde deduclicn.as dobnpd m Reaul.nonA. P w A 1(29 CFR Subettle A), I..cod by Me Sepmurr Of L.tne coder the Cnpriand Ac 946 6.4 Stu 108.TY 91. 1;Th Stet AST, dO It 3 C 3760, nd ow: I a mdN s Stu WNiM 6Au L Fl[A TA s t M Al A Aw ! &Ppix mail 1 , aAMOW CU lb Thei ..Y'payrolls otAerwise e..der Mu comnct ih. '".aed 1.+ he Aebndned f.v the aW,.Ppn.d AI poerccl ,h,rort,plele,t th<w.Wa ores foe labaneA of meehwi<a ronbtAN IthiBin Arc not lee,than the AR I,,.ble RARE mO,A conuinad m ..y w.µe O.tetmin.tlo.Ntcoepwatad onto.the cu.teact{ that the e1.AAlhculon.wt forth thee.for e.,%lAhRR,oe meeA.ntc con loan with the"ik he peeloemed It ThAt .ny apPrcRliceA empL,, m the at,ove pens.,R h,ly mµletervJ m a bona tide Apprvnu.vehtp peuKrAm requtered With A Suls ApprcnuceAlup .Retry wceRnu.d by the E,irevu of Apprtmmpsb.P and TiammO UNled Sbme DeyMmant of LAMr.or if so such-coMIAAA.eency e.nta in A Sine, OR mputermd With the Rufv.9 of APPn•Aucrehi ArM Twmmv.VAR e Emss Dep.rTment of LAW, P NI Thu: (A) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS Will addition t the fll hourly w.µs nilA paid h coca lalwh.at W,..nw 1lAroJ m she rbnre.rc[eeencrd pay dl. .Im, l't of fetttRe benefits as tatted in the contrvct tO hem o wdl be madp to.epPeopAAbe peJRrAm.fm rho E.wlu Of..,,h pmplryeea. escepl ..nta+l m Sectlon AL'I below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each LAbreer or mu rA.nc lured in the#b ,,rclemnc N p.ymlt h..hi,..p..d Ac iiR,. A an lAe p.yoll. An I"'ameunt nm Is tA.n tAs.Am or MA RPOIL-Ne b.uc hoorll waµe ral.plus th.asmunt of she ee.palnd Dinle bette a fua Aa 11.1d the<Rahtscl,ercp•w nwud m sectlo.Hc)hRo* 1<I FRCEPTIONS E%CEPTIONICRAPT) EXPLANATION r�aier� PAvRou Cc. Cc&-, zv w.>zc P .RWN•>r ,.A., .,,,�»,AA..,,ea,.,9,ne<.,. ..a,. ...Awe..np o.Itl..R.�A OM.L.Na.alR-t/ak Rf O.c.Reer SI Ion -BE— .�E�./� °..i�o:Ri:ER:o°.v °�o t:of PLEASF NFADACftn-P.iY IIVG INITRUMONS sm, as;I b 1.447,T b lu,Gl.f41N,Hu.101. 101 '' aaawe�+¢ w i ..a Ifs;r.l.r..an,rNla r,u.6 LOCAL PUBLIC WORKS PAYROLL REPORTING FORM n AEfORf CULYLE7ING ANY PANT OF TI1f5 FO RI P.Im Maw: P..I«I LKMIw'ICNa.a Taw,Cat,N+4f PLEASE WAIT!PO EM LIRE TRI$ 123456 � 8W Y faRPN araper Ya. LyNpw'a IRf Na. 1ar hrlM feM PM.1 NaMw L.0►grail PRINT RITN GALL PRINT PEN OR TY►E IEnre...L..rr Mr.re Nu'La.r 0t1po /e•r"�•PAI I. - PgGE GL PPGES m b n OrM».ne LEA VE BL ANAIs Graff aROWI (hell I+gYll[ Soua1 Sscwtlr O<cupa- Par Actw1 prnW w Ne.ka _ b Occupy Par Actual eam.a an Rarf _ p • Numaar Ilan Is Pert barn Tn Proper R..tr :6 S4u NumkuU,an Iron panel Nearf rNrf propel - p +ru- k cope ease Y+ded ror mn urem 3� Y p+Y prnpp R.Y.f colt cone ..Iu.4 Ier 14O �r b t oav w•rne 'i olepC f 4 Ji n M O fl .4 Y N ai {t M J T M M fr N IS {t a •f N 1 1( 2 1/ 1 1( IL S x t - 7 22 ( 21 fS t x n lIf 24 14 r YfnT Dry Yet Eplc>aae IRfM a4+re aR ,*"6; '.1. pAT[►RE►ARLW. Ines«d Nw VAIL TO: Chit,IRWIN*57fMw aM SwI Divisim Nave a ft'.PNpwmt ROW r i4YasYr --— Ecagmi<DereYtRtN AMai"in U S.DfPNERtN7m".10 r l frewwaer :a.nmla W nyR Rwo 6415,Olt Gores III ell"Sub.ZIP 1 W St.r CAMObtle An mm.11.111. Area COIN Mun4r ` -- TLLLPMOP[: !„_j iaf W I T.Iawmna N. W Goan Arr Caw NCROw LEMIRNINI.D.C.I" - u¢wr.o<afua+v Y.f."PARTN[NT OF LaRON f_ _ wAea.TIP Noun ae.wen .1TATEM ENT OF COM PLIANCE A • 4te.0 N e.. Yr 46RI491 D.I. May 10. 1978 arlfaia Mbitworth. pa roll Clerk r 1,TMt i My.,..,per .. .,. .r .., :.. 'ion• jA£. :he Talbot gill Pump Static.,. pu�dp�e.�r:.a.r.,,n., may 1�+R end end!..,rheyay., %( may 7Q xti Pnr.un. rT,Plm,<a ae wed p.<tect its, been px,.f the tvk reetlT rade.e.,ded Mat—eebaM.lyre be«n o.w'a IF male..user directly o,udrmcrlT to ter d heltilf,,(.Fie Tri_ Ctate aeaatraetien Inc fmn usr Nil w 11 w •C s.v.Tx rcu!tt� «s eened It, nv pen<n anb thus ten O.A,u:ttonz txre heed made.XeMr dirtied, rr Wo.XtIV Opp OF,full..,..soil Iry Aprye M. arbw tMn InnsdalsWe dedne", to..defzned n Rppnlalten.. Pan 3 f'.O CFR Sids"IF A,, ,X.,X O b, .M 5ernl.n �,L.Mr nndr„eM Cepei.ni A.:. x..,.mdod fd St.1 wa hd S4A ION. 77 Su. ,n). `n Su! 357, do r. s e :'R;. .>d - tai•�.hol.�+ 9�FICA_Ta_xee_- - Medical Aid & Supplemental Pension ) i 3y Th em P•xmll.oMx'wux ur.hr.Ms<Vntgrl neueed IP M .vnnov.d fur.M.pore'by,the period.n vmea!xnd A.wrpr&te,R e-xe Im bb.r.ranr n<rMmc.voma,.nd th.nan an nor •'hen<he alpliteble wage ntez r inttp p a,v gape deteds--t n ten<tPnated iron the rW.VKI, !h.e the claa.rl+x•wi�.a x! fudh Mee. in,er<h l.henr or peeMrnrt eon loan. ilh tint wvrh n,derf.,een ,.T rnel w, aq,mm.<pe eppt Ied IF the-Wie perwd Mee d.ly qrN�......hm.Ldr.ppnrtUttaMP prv:pr.p raq:Ntrred w'!h S,ate app.ennrerMp aF.w rerapmeed br the Uun.0 of A{pnn:=«rhtF and TnpAMp, ud-led SYMe Depannt»r..1 Lahr.w d rm •h nroRtruad opera'.ertne m Le" e fiv xn repbtr wd..��-he Rmr,of All` -Tine.hip.rid Tninmd.l'n,•ed ,dt Then fat RUERE FRINGE HLNEI ITS ARE PAID TU APPROVED PLASS P"011.6R PR(%YtAR9 x,- In addumn Io its,Ms M,miv wpe ntr.Pad.e eub=x mrn ter m<,.Mu.. Irmed m the W.w nfe,m.«d p , U• PaEpen!e of$MOW beiii.a listed in.M contra.. have Ire.n rill b.pale!n.ppepnala,,se. Ne ne,heneHr of...A eppl«4 M.. eXtYp ..wend ui Se,re+n Ali r be].. (h, VNERE FRISCIE UENEFIT6 ARE PAID lR CASH he,it LaOwn w wr,:hssN Irnwd,n OF.Iww..loomed p.vn.li h.+ 'r«n pwra.s '.4w4ded F. tM pxvrvll xn...t.1 I...Npp its Opp"t applreAh bn ete.h' we, ,r1, N.p. nI.plus the. nl of the hgyn rd hmpe M!nPMa..I,aM rn,M.onto.! v-s ed I EXCEPTION Cp.fi EMKANATIDM Arlene Whitworth, Payroll Clerk J R.B.No,e1R 2AF E na Orcemb+JI 1})} [o-ru a f.onAwvr[NTw.cawlafe PLEASE READ ACCOMPANYING INSTRDCTN/NS RF.FORE W.YPLETiNG ANY PART OF THIS FO04 a In;nt.fa..n,r:+h 1,a.a LOCAL PUBLIC WORKS PAYROLL REPORTMiG FORM F([MPt NMP: PIPIPs1 LPc~ICH,W Tw .cWW,Ba1N IIEA[!•RIR NYRRlM LIRI:MIS: 1 23456 � 890 lr F. w M.IPLt N.. bW W,w,IRS N.. I.[Fww}1e P.rl.11 RPwMI Lap P"ll lbPIMIT wTN RAAL/MT M-A WPl Or. rr. ( E..n.••t•.rt rlru a vw..La.. �IJI P,-,,h.Ae,anl.<I_ PAGE __ OF vRt:ES [ 1{ » w OrPan..a.L CAVE OI.ANK - 1 WOS{[NPYnI West. V'f0et IKYnt TgPhl Suul S.L.rih OC[u0a pay Ac:ual urrrM an p (_ focal AWnlr OttuOa' .. Aow's e.wpoM pre. : E R'iTE11 I..P PL(r 11WAf Urf F101fLt C+< l NfxbH tlPl1 Ir PP NWA\ t11N[IPIILI L POI COGP RPrYIJ IPI Mrt oMm p yTr COO! <Pe. Pllee 101111r{ PaY PPrroO PIPueP L f = o.r WnN s aroreP z y • C Sri •Y el s N OO 11 .f ss [I O. OO •. eO eP OO t if 2 1 1 If 5 IE 1 ZI 2 22 - ! 21 Y 25 12 t1 IZ 21 Al UTIM roew Oq Y. Ewpar..f Imw an.an errybrtl by MR PNEFueR: tu.<L.rr.l yr. *AFL TO: Chid,kIMNMi1N%mom nl 5wvkn Oi,Mw w+MAOlnu__ E D*"I+NM AM,kkbwM Uwe w 4f.P P ss MP G.S.ne It CN I' N�Pwt..ctr f feem,ufP a•rrI oh.star,VP Rww 0415.MW fgBNwa Ply. AN.Cnee NInbA a..[tw 1117 �l f bu.O.C.nhog � Avows.R.E. T4.lPNOIIl: T.1.pNnP.No.w Lw+uct. Awe CPII C Mwro.i - ,�; u.cew.PP u.u.uo A u+�aEPAcTWoNTawwopR STATEMENT OF COMPLIANCE • A�;.�At"P,�:.°r, ,t ptaf, r.a,,,. May 3. 1978 1 Ar -- 6pp, plhitworiT+ D.yroll rl ark done l l rh.t l w+ .r.aPerrtae th.Payment�t tb pet.nn. .,,,, Tri-S ion. Inc. Talbot RY1,11 _, chat durtnv<hr"I'll Pen..d.omsm,xm¢on MaZ]�lw ..I�rri 1 and end:-.a th. �+d' ayym- YRY its- alb peeW�na I. emplorea o aua pwle<I nay. c.n ;.e,d m. rwu .eKly wades earned d e!m•mbner bare been or will be .de ether direr tlr.r ".heal,In or fin behall of ii.- Tri- State COEtatruetion zne lrrm 9be hdl ymWv wahw earned by any penm and Ihat en ded 9c!:�ns Ra+e then made otter dinseu,ar IdsreGtly fern:the,Na-We.[need by any person. oihx than psnauubl.deduction.as definad m ReRulwoha Part 3 iN CPR Subtitle, AI, at aad by the Serwon of Leto,under the C land Ac!. .e ase.rnd.d NA St., faA 41 Stat IM 72 Sul 17 pry SW! J"-1U L•S C .'Aci,ar.d d..rnbed blow Wi hholding & PICA Taxee _ Medical Aid & Supplemental Pension (kl 131 That aa, p...olle m9.rw:m under in,.wnruot uauved u be, .msn"Ied for the sbrro Period are,-0 and/ce:plete, that the wa¢. Wie for lenses",mrGhaoe.ro.9aued tAere,n ere on, leea than the appllc.ble watts .is. ronte9ned in wa¢e drurnl:ratmn.near "Word .inthe.......; he, he set forth re a theovm to,earh labor n,mrh r."Coo Ibem with the wee[he parlOeped X Ttet ant .ry.tenncea red loyed en the etwre pan.d.rr A•19 sa[,eteehd to a bona fide a .pptenfirovhtp pm¢r.m rr[:ate:ed h . State, appnnbanen.p a¢enC9 ",o"'ised by the a.ma. of a o-nl:e.ah9 and Traminin¢. Irm,ad $.is.D L.M,,or,f is,euch mraemw.A p epaFlmre,of Lute.D a[eecr ea,iis ne•Sul. .rr m.:xo-sad wd!,the Nuroee�f Apprcnnr.4dV end TaUmna. Uo,od apanalent of Letter !1 That: ta) WHERF FRIM6F.HEREFiTS ARF PAID TO APPkU%'CD PLANS FUNDS.OR PROGRAMS x' in.ddlRan rn th,bras hourly wade ute."'d to each lnbotes or mechame listed in the ab ra elrn,. oY pry IAL Paym.ma al 1r;na- baneflu.a li.lud in the rOnl<net have been or will be mad.to.pptupnaty pnrytrem. an the bnefm of such eTPlaveas eacgn as ended in Sarlpm lea)below b: RfiF.RF FRINf.E MNeFITS ARE.PAID IR CASN _. F.ach Le1..rrr or meit rif listed is the above rtfevertd Payroll Ran ben paid as indwm.d oe 'he Mrroli, n¢mount NN fro than the.um of the appUcable basic hourly paAs sale Plan the smaunt of the,..._:rod Fmpe benefits as Iratet In the c.nmect,--tes as noted In seellot 1,1`ol,. FXI-EPIIONS I!XCEPTH) (CRAFT, EXPLANATION uaWsa Arlan. Whitworth, Payroll Clerk � n v_ nw a s e C higWCTOW Ow fJaCJx Ta..0•1a r6 fMw RNa��t/af1 .JWCw.1t<rr:..OltY pn[Ctlr vaOM vu[nY �.OI OOGWLwef oAI.W.Rp.uW-a{f le.oe.e..^w n SE» PLEASE READ ACOVP4NY7NG INSTRDC7MA6 bN b M,LL..a.]{f,f•or.I%. 104 'r moxorm o r —1 Ifs,P.L.14r ,nn•1,M L LOCAL PUBLIC WORKS PAYROLL REPORTWO FORM BEFORE(XINPLETRfG ANY PAR70E MS FO RII IN owl Ware: ►ryacl LaNt1Np:IC1b.w T.,C 11.¢fM PLEASE WWLTf YYMEAi 11A[THIS: 123456 -78W LY FN.rM fnque..e. ylo..'+In W.. Pq Feld LNN PaTrell■~ bPJIRIIIT WITW WALL PEIIWT KO Of TYrftif .11_,�L 1 Enn.••L.•�!rn.a n rw.Lar. P ,.n Y•r PAGE OF �_ PAGES n » » IN { w 0 —LEAYEEAVE WL SLAM AMA Greu.wount GrNs.Wolmt Z Socul SacuntY Occupy PSJAO"I NInfO on g W.... c 0owpa P.Y Actaola1n11ontmn Pmnears en p•gecl ! Pre.. f fi Souai Secwrry n n :+ Mra elt W.N.pe CNWornN Ior I I une T- Ruwf.r N.. 3!` cWe cope •.f. . M. L NY NlIN af'L ploYsp 2'g3y NY Nr..e 1 If 1W i f 21 27 24 if 25 II1 261 12 27 17 >ti 1A I 2f is is Lela Oy Y., frwoye.+In10 aMw w.wgINN EY WAn PWfPAefW: I(Ters,,,el M. WL TO: Chief.MktwMion In% d SEYYItN CNi+iee War cY Pee+N Prepwmf KNp14 •p•.{pwyr Eenmeie VMMPWrt AIWiMfl," an.t Apo�z.` U.S.Deorbwm of CEWrrte -- M[NbxYr MWAIPN o r-yA COSY.SMU,ZIP -- Boom Bay,BEM c^WW w BMf. IRE St.adCeetlWOEn Afnw,M.W. Arm tea. WImIMr manrw � Wmikkoof.D.C.B27f T[lfPP011E: T<ndme Nc.of Cmrxl Ana LON C /III~ — d0! STANDMD ►OD11 - 25' ��__, xapx rr ird rertod MUNTNLY IMPLur yt IMontn, reed �t' 1976) UTILIZATION KLeOkT preoerlb" by us Dept. or ,rtor (D/CCtli (see reverse for %"rtwct Lwu) 1-41 This report is required by fascutive 0ro7 n246, Srctlon 20). yellers to report can result in sanctions which include suspeneton, terelnatlon, cancellations or dobarment of (asno WA :eeatlp of DoePllanw assngl Ffool (sees ana 10"U" of eontrooter) Civil Rights Division Tri-Stat . .Onstruction, Inc, Economic Development Admin stvation 959 - 1.k Avenue N.E. 1700 Westlake Avenue Bellevue, Washington 98004 Seattle, Washington 98109 City ut kenton LOA Project No. ' _ _ r Project aerlption: Pall, t t1, 11 Total how Waft Noure of I"loynent lien roctnotai =1no. nunbor r Class! a. W^ at of of his. .. et lw Gl by Coapaln's Ysee (I.D.) Tessa ons Iota ela.a �1O na. "�$A ale LvTI alneri tap WWI"- sea Li Tri-State Constr- ,.ctiun. Inc. -Iprs. T AD ".line True); 'ame .riv r4 AD T Tt AD r Tr ,"w, 0 Leta a -�Ian e�u�r/e aro T Me . Date stanad v ophone r �A,(• HiaeiR^Iatf� linoivaa trw Coeal nr1', ; a WhltworLh, �"t. . May 2• 1978 1'".it,) 455-257� 4J1 Tri-State C^nstriction, ALL FEDERALLY INVOLVED COW AC.S GF rHElnc, iv AREA OF Ben Loll HDKTOVN PLAN FOR MONTH OP &prit Wa a"n�CC yj Southwest Washington :OVERMENf AGENCY CONTRACT NIMBLK LDCATION _ }AMOUNT iC4PL.,. rTED PROJECTED COMPLETION DATB 3conomic Development EDA/LPW Talbot Hill Pvnp 214,489.D'? 100 n_teLer, 1971 6 inistratirn 07-51-239OR Station ALL NON-FEDERAL CONII+A( rS (AWARDLD SI:RSERL'ENT TO EGAdS57STED CONTRACT) IN PLAN AREA FOR ABOVE MONTH "NAML,UP CCNIRACT CONTRACT NLMBPR LOCATION } AMODNI' S O MPLETE CA E None • CITY OY 4XION WA•LPb l k KAA,,4 41Nuk I'Y Wa1NLbS PJRENPRISE 1t11LIZAT1ON NEWINT ram_ WNIN/ttAlt Aoril 1970 Yrolc.t a eiOA/LPW 07-5 1-2 3908 Title Ta1LOt lIf i l �•umia �tatton Wntract Br450 (LAC e Prime Contractor _TL1-Mate CJn9trUCtL #A It" runswm Wllar AW"t Allo,eted - f (s +_� of Cmtrrct) -`— Minority Enterprise Same B Address Type of hulk Amount paid o lk5 Number Nunth None 1 i 1, I 1 I i i I i I 1 i i Subtotal [his keport 1 AWunt Meld - Prior kepurts ; Cwbabed Tutel Poymwrts IF (II Percentye at Contract) -- Prep+red By; Arlane Whitworth Pate: 5-2-78 Tit=�' ._, _, eov roll clerk »•eR..p.oav wv�po. STATEMENT OF COMPLIANCE 1978 • • --Arleney _ Jgt•oor_th- Ihi.m payroll Clerk P+:�. f!Cc PertM4 e - Talbot Till Tu-5ta.te Coss.ructiQna. :nc. 78 ..ed e, '. 12th. April 6th A -April �---__ !v 78 Yn . �,.... i. , -t ..hAf State Cons=ruction, Inc. ""''" 11 Tii,- _._ , IWI wee.tr exReY.,,mad by em Peman.rd i. n k.do r P. . , .- .t frenma alder fheY tiJtl nJ Sf t IU4 ,_ R.. - ."r( LAmr xnder eAr Ca1al.nd.2."A A.I dedx.;.om .dnLnad ..l,ed Mtnr: i ax ersen. �M Sf.i ___ Withholding &_FICA Taxes Medical Aid 6 Su 1 r____�p edReTltr.l_Ysn.ion (�� F That my Pq.:Ila mhnwtw uMr.eMu a - — +stet JetarmrnYrrm fLburen.n mncn.n - umbeRd tneren.f M-.vlYontrd rw Ids ebne PenoJ ew•.n...:r and.a:nPlem, napm+a.l mm the rh.t the etex .n<fcylt,Y�.n+fartd Mre.�n for Yuh lat�uem un<mcn v am (rm WIM flm raa;na Perfarmed n • � + �atcan (.i) Thn em ep(rtn4.+a anx+lavedron�h,.ba.e P»mW.1.duly,epum'd u .bmu hde aPPrenncexh.P PNRrom re%axxercd IxMr! htefe appro.1111"whip Ydencc c [MaM t,y the e 1 tM eucX 'afmiRvd f%nxR euatf!n•5•v:r, rc rcpieterodn�htreW�P and Tl.lalnx. Unnrd 5h.tex D Sore.11^WNmrnt-t la,bar e v hn Rurceu +1 API'*^ h.endm end T.eMm,rmen•ul N! Thee A Vrured hl WHERE sRINOE ftE 1F;F'•^S ARE:PAID 10 ApMNn'FO PLANS. FUN OS.OR MIOCdtAMS . 'n addtlmp to<he•NYic hoa.ix ware telex f-14 e I .b latwr<r,,.n•...h.nt. 1,.t,d m the aMve reterenrrW.Pay. nll. paFmfnyY W fnaRe Mmiatf of hY:ed m thv aan,.o hew Nea.,will to teede to appNfx.tfro pnyrxmx (.r ens lwneln W awh emPlovnex. euryl of nnred m Seen,e M-./heioW ih xtIPRE IMIWOE BENE"TS ALA PAIO.IN CASH LE^:d 4bter or meelHnic ]ifud nl the Wove rtb•wncrd PnvN.O Me been P•m ffM,<ffoJ an inv Mvmtl. cmoxni nol teu tdan tfrt Yum of the YPPhC.b{n bYY4'dpWly WYAe e1P plai Iho xaount a(mn n't)yrmJ(nnpe eA lif tnd M tde camnct,except of nwed in eectlun P.1 IMtOW !Ya E:PTIONIIONS ' EXCEPTION tCRAPT� E APLANATtON Arlene Whitworth, Payrcll Clerk �' , • I al � �_ momms ® ® e. ■■ ■■■ ■ ■! ■■H!H■ o■ N mom on■�■ ■■■■monoit ■ ■■ ■■ MEMO ■■�■ ■■ !!0 n■■o■in ==o■N ■ ! `!l inlnMEMO ©■��!! ME mom on nownerva 0 �N■!■■! ■!■■■ rN■■lioon ■o� mom Mom !■■=■■■■nnlo■III ■: ■Noon■ mumCna ss■n■■�. o onN■■ ■ ■ 1pul nlm�■■ mom@ ■0 sol■� is 0 on w %to ■�� o■�ii MEMO sonlion 0 _: _! ■■■_ ■_■'�■■■■n■o=Iil�i■■■=■■■ ■ !■ooIi■■ on ■■■■■!oo!■■■■o■n■■ ■ 111 ■■o■ NMI ■ ■■o■■n mma n■■H■on■■a n■so■ ■■ :■o■::!©■■u;■■:■!!N■■■/■■■oso •%oil ■■ ■' noon ■ m ■ ■ ■■ ■�■�mo11 moo ■ ■ !!� o■■n■■■!■!■■■N ■ ■lions ■■I■■�■no■on now ■ son��som!■■■■■■■■H!■■■■!!■ ■ ■ ■! !o■ u.w.ocRAetw[wT ov lAsoR• STATEMENT OF COMP_:ANCE � n A "r'a i aµD wouw ernn°w a.ra•r�Ran.a e, 4a Smvt Hatt April. 19, 1978 1 Arlene whitwor_Lt>___ paysnl� c1e.t U r•' t I Dss ar sapervrue the Wvmene of tM M'rsnne.mP;.,en bt Tri—Ct8^,1�_,� }i T n the Talbot Hi mar dufmR tnr Payndl Wnad.ommenemR nn mal ilM.y col„ y,l__ fu�Yntl endanR melgjJFav•1 L�na.�r•i 1 lu �.y. �. all pervans emykn'ed on aa.D pro{en yv< Leen Wld the loft =eakly weA<i eameA,the:n,rchata hear Iven m w.11 ha made ether dmrrty n.rrdirectlT v+.v on nehtll of wid Tri— Stwto aLnne}nzn} p _T�tnm the full wn<41v asgez wn.;J .am on end+Poe na deAucKVns have hnln mYde cube,drrcaly:+ rMv«-Vvthe 1Y13 wales Hama nY 1m1 peraan other thin pt,mlmbl<dedueuvna aA drtmN RYµula.Ona, part 3 4�9 CFR Subnnle A, .aaaed by the Sermran of E-Wl under Ih<CnpnlanI Ao. as Ymrnded (AR Stet "S n3 SW IN. 72 St.- W.!n Sral J;7, 40 V S C 2. .and des, ,b,d nrlaw: Withholding 6 FICA Taxes _ Medie�l Aid h supple�gntal Pension 11jj r t1 Tnat am' pavc,4z,;n<rwrye under mu c-mn mDuned e,1s aw o"d L.e the aM.!P•+mJ arc omeee aM comP(ne.that the wage qua for IaMteraw mr ,h cs conlpne thnmin are nm less than Me aPPlu-anle wage nha eohlamed m anti wp¢r dltemin[pw IrecarppMeN mlo 3h, the o.mrn[Y. mar, rh!ctaear(Keeranx scr(ortM1 mercer(or each fabum m mecnYmc con form with me work hr perfannod. rJi Th.'a..v apprcmmea employlA m me'L "p<n mf<n•dYlx re¢ruexd w.L•na ftde aPPttnll ce YnlP P^'µr+m teKtzv<rtd wrth a State apPrennceah,p aµunly rero¢nued by the bureau cf Apprcnbceanrp and Trunm¢. United Smtea Depanmmr o{ I.abJr,v,r�{n0 aYrn I ¢nlalA a¢<ncY.'Vlore In Y gIYfP ar!R•¢rrlMrld wnh me RYII'fu,•f A.......Kfahlp and Tm.nmµ.Vnrted Bte[ee Department of Lalyr {ir Thm: (a• "FRE FRINGE BENEFITS ARF_PAID TO APPROVED PLANS FVNDS.OR PROGRAMS X In YM10.on m ens henc hau.ly woos rues paid ro exh l l,n ,oY mreham. Lmed m me abnre rcfercncrd pw ..d(, payments n(4ergw Mnellea xa hzmd rn the rYnbaG hair naen n wit) be•mode to apPmPrtare Pr•.R•ama the tha•faneld of each empWyerz. exrepl au mrfrd m Sanien Hq nelow ('m ¢HF,RE FR;NCE fW-%FnTS ARE PAID IN CASs{ 6x-rt LYhattr of mechanm bated in me oboe. mfvennN Puvrall hoe taco P.,d an rrduated np the WMll. •n amount wt IMa!h.n the sum Y(the apphcahle bazlr Ywmly wade nits Pfas rkr amount at oho npunld henna•tanetirs as(fated.n:he uuntrert,larept as oared m aenlnn 1{vl below : 4TCF.YTONS [¢CEaTIDwIQAFP __ EIPLARATl0w a[aan.x Arlene Whitworth, payroll Clark _ -• .'s .. ' — :•Dw nn zuµco�r wac.aa . ... .c i•6e f4! 4N f[G TTa`[f V FM NLHE rVW YV hCwaaE Twr,epwy Orw6CtaY <aau TNa aV r•..O<DaCW[NYr O.M,N.M0,IIR M*E +a N "W 31 19)) tw:oryc was PLEASE READ ACCVWPANY)NG INi(RUC7701aS Tnb.en.�I.eawn..ue1 A No,RL.Ib.b1.3.a..101, IOa. a [c w Ids.P.L.ra.a[),TMe 1,n.1. LOCAL PUBLIC WORKS PAYROLL REPORTING POfDA BEFORE COMPLETING ANY PANT OF 1NlS FO RI Prefect NW P'.1.1 LOCMIN:Icily,_:tew.C.".Halal -- PL[AX MdT[MIMR[Rf LIR[TMId. 1234567890 VT.WIff ONLY PatarN P,4W■a. FaPNwr'>Ins Ra. Ply PLAIN[aM1 Pap111 MMIM, Ipwl jpPmxT[ITN MLL PDMT PEN OR TYPE 1 I I 1 I I Ib Uy_ Yr. ( Eun•i L":!rFie i+lour Le.• > e 2> N w—,t=•�i+nroie<r- PALE or PAGES 0*.rr.rAr.LEAVE G rej!amount Gmp amoum • So<ml SecmrtY Occupy PaY ACWeI ne0 on E Weeea _ Occupy- PaY Ac Wal gamed en w + tmn Perm nee" �rolecr 2i ".I • e fi qzz 3d<ul Stcurrp tren pmv. . f MumOv ene Q MumOa pvmd nMra tM{Dmiect [NOS g code Cpde Norn[e n - gg i[[[ code code wor4d !er IMs Ia: GSY Po a0 p.Yed z y i Ory Ceuod - 'g plOYN 6 f W f iW >I tl ea Sr !a N er 62 Is N J 37 N .f !1 N {1 el [! N 16 17 7 _ it / n i 21 1 22 t 73 2/ 75 13 _ _ 2f 12 27 13 2t II 29 IS 30 IIInf1 Dw Year fAotyNa II{tld a0dw.re amIlOYed OY MT[IRVAR[M: - .p Nel Mama MAIL (0' CMie,inbom Ioe SYf1eu and SMvius DI[Itim Na APer+m PnpRma PepW �' CO iclw EtmoRic 0{[e10PaIN AttlRishtlI"Utut bama._ U.S.Opvlwt A CtNNaIEP Yewea-r Idmbfi d at rlpl Rum B415.Mai C[RRNp Oft. Crry,Svle.ZIP 146 St.MW C[Rt11Ml"AIMet,K.W. Aran Caa Meetr raw ) RPAW - MIr,D-C.M29 T[L[ADII[: � Tal[pMN No.ul Lmbn Amy Cade� �11elltly - lw+pa axoTrTi wan owR• STATEMENT EMENT OF COMPLIANCE • Fwm Arve+e,° Au.y.r P,.r,p Ra µl109.1 Date April 26e 1978 i. ♦rlene svhitwrtll Payroll m narmnr sea,c: I Tna,I par or eapen9+e tM WYmen,oI Me prn.m,emDl„Xed bTTri_$ta �tractiOn Inc. Me —Tallest Hill MiOt . rna,au.mu Miyq -4 rota e�mJ�� rR, vavnD venom,wmmeazrny an �Ea.x „r April n 1aZ$aria enemy M{�IE.y,f April _ I478. al: Iwre„n. rmpWree ,„„f protein h., bead pa,e m.• rid: xsekly -ayes lamed.ton no oboes nave Men err n'ID M Haar vithet drnrUr or rMarettlr±n,.,,n Mhaff of said Tri-_. State Cone traction Inc e ,nr rwl weekly wags+eamed •+ aa,a,arlw 4Y a r penon ariq that m grducrMln haw been made enher dnerd,'or,miei(ro,RrerNII wage.r.me m d b,a person nth,rna,pemsuwe dadurnen,.a defined In M"-Iiilmns. Pan S f29 CFR SuMnle A). I...ed by Ln A rrrn,v "( Labor under the Copeland A,r ,e amender (aS Stsl Wa,1 grit IOB. Aal 95C;`A Siat JCT;40 U S C 17hr), .W JaarnMtl Mlew: — _w;i�ho'dc TSXE R'IC:+ TiXX�a Medical Aid a Supplemental Pe� (l) That an, D+,rolls.,enerwue uneet thin contract rpwred In be wtxnIned tar the afw.;, nod arcaid end rompl+re,Mm the wage nit.I.,I.bneer.oe we.hawta uumanrW thine-os rill leas lhan the ap4`Frcawr wage rnra ,.I.i.d r inam wage determaarvon i ve,ur.,"into r,a eunew,r: �he,for cbanhen4uns rot funh thrum ter earn law.,m,erhaNr uan form with the with he pnfuened wrt 1)aThatten parser..ire e,mrd in Ma alwvs Mmwi art dour na,atered m e W.na Ole ap rni,wsh,D Prulnn ragnin nW %,"h or a nit euvh nrngnaed'rra it exa is M Sin i aurc.. f Appmn:,viny .M Tnunr, Umraq SUBS Depame,va,rf State, Depane.nt of Lana„ 's m a am repxurcd wit F.•he Bureau..l Appn nna.e.hy+rid Tnmma, Uvlefl (41 7T.t (•) WHERE FRDICE BENEFITS ARE PAID TO APPROVED PLATES. t'UNDS.OR p,,,,AMS j(,- In adaumn n rh Mxl,nrmh ways urea pa•d m Waco LWre.nl mrrhamr tni"d in the ak-,.rejen.,.4 p•, n41. Pvivrrm.o, nrya".fit. in,Land in,M vuntr¢t have been nr will be nadir ru ayprapriarr Drq[r.ms for the Mnehl of"en emPluraas except ere rnnM in Srcf ices d(.)Ntnw (b) WHERE FRINGE eENSFM ARE.PAID IN tIASH Exit L.Mm,a,,erhanm Ibne ,n Me *nova nfenntt 1 pnrnU hu Mrn paid.a 4ndlcand un •M an.mono,ml leas than the sum nI the applrrawe bans bnon aM !!' bamfns w IyFd In the c.nrn<t except a...,ad in aa,ttrn He)+Mi.. pl.,,IM amoune of Marcqurrcd RI,Ce 4:YCFPTIOSS EXCEPTION CRArTI EXPLANATION Arlene Whitworth, Payroll Clerk Euria aM.J1A ,. e._ a)♦ DAL&ft.•IR.IS%Ewa.D«aerlw SI S "iD-''i eaonww oi.i�e:N.u:�'':wr� :K� m MPA.YYINGIRSTROCTIONS : . nr..NN.r..Yr.w�+.•.,w,P,L,ea-YT,s....rDs. I•i. •a-aaY,Tax 1,Ck-I LOCAL PU/LIC STORKS PAYROLL REPORTING POW A.TY PART OF TRlS iYJ P.*e,Nr, PrNecY LYNIY:ICh♦,N Tam,4 tj.NaN MURDERS LMP"IS' 678gO tl LY !.•NN ReNa M. Wr.Yw'.IM�N. /q AIY lnM /.Yrori M.NUN lM PYP•:r POINT PEM ON TYP! r J _LL..� OY I 1 Emv..L.. A rFn a your Lear _,— PAGE _EAPrare-._ Of RAGES 0 a n n Y ..LEA G'e.i irI14Yn1 1e<Y. Crti.anOYni Nel4• Spual S•[wr1Y Oc[upP PaY A[Ww tarns•Y a OccaD a PeY A, ' a•YeA N - • (j! frM err C<Yrt 111 r.plur<[t DI<Y. b SDcral Se(urrtY IrM IIOC I.gll. tRr.M<I<[t pne♦. .y NYNUeI cp•e CN• RerY•• far IYn wren DaY 4 �$ Num4er coo< cD0< M14E DaY ip ler. D p14r.0 yg D<r'DU Db>e! C t■E 0<naC � Z • i Nw E a N i J .r Y fl .a Y � ar iS Y Y r Y N V <a Y P al p Y 1 4— Ii t — /2 1J 3 e[ r If 7 r 1! r S � i b S Z! 2 22 7 f 1 n — f 2f1 • r zs u � 12 22 s u 29 38 R}rR Oq Y•w ENDNYa.Uaa•as•M.Y•pb/Y•Y MT[PRIPY[b. i Itl.as u..t i A. __ NAIL TO: MIM.bkmdM Sf WN.al S•r<k-OfSIfNR M•a a Psr.Y/NDIN/N.UwI �' E<YxNic OeYeNPSpI MwIEURM U S.GENSrRENI M Cs MIME New cMWWWcl o [T[.11aRaa 4wr+w<a r:Drl Gry.sax.DP / _ _ _ u.'a['comk*um A9Qw N.\. Aru OWNismo.r --—-- �r.rw tl T•byan<Nt.Yr CDeuct A.ea GY\�_�NUM - R/AYKEa,O.C.30 Tu[/MONe i - 211 • •iPcrtth •r oe (MIS. 1976 1�7L) NUNTNLL bth Ln ML'•; la•nM, t•grl ►P*Pwml•a by we No%. of yqr (orca UTILIZATION aLYOAT la« r.••r•• for Wtry•ttr•1 March 1978 7Ale report to nptiftrd hr tgaeutive Or dot 11246, Se4tleo 101. /all raault to AN"tins& Mich Inc Ludt w•palllco, t•nlga tl w., caacal lat ape Ofva"Ttt••om t I Irate YN 1a•el/M Be 0"WILY.r A40mv) PC", (Ya• Yu/ :•••tlr K ••atra•NI) v11 luyht• Division Tit-Stale Construction, Inc. t onomie Devalopmont Admin rtrution 959 - 10b Avenue N.E. e ! 00 Westlake Avenue Bellevue, weshingiun 96004 S, attle, Washington 9ti109 LI A hro,Hot Mo. Cl LY of Renton e Pfro�ecc aoription: n.na Il; ; 1 t•1 sort Yoyr• •f anrlofq•rt la•• ra,troNl MIND-1 W ••oboe r Cleo" Arof at of R tMp1r`• else t[qb flw. rl•" r. A.1W %aI tote] al[rrl &Bob, 1 I T.r.I tlon• 7'•N N3•.• rWl•n r••In• •- laalr ••• wort I•bna 1• rA� ••. Tri-State Constr- uction, Inc. Nre, Tr rut Lame itr Tx Tr If Tr 'c•/pj•r�y� f��1.y�4�� •��.�r-,w�or•/1Yt • pot• �l{n•e • • orw r GGr�1fl L(/••(ctY�/rl�c. IInolue• tr•o C4e•1 Ai ioLr let it wart Mar. J1, 117 d Alk v I h 44-R 96 STANDARD ►ORM - 157 ■•Dort Sri •rind (Aug. 1976) MONTHLY EMPl OYMZIq IbntA, root) preeorlea ►r the Dept. of Labor (gcCrl UTILIZATION REPORT Ids rnaree for 'P TAle report 1d rqulnd 6y teecutlre Order 111-6. Section 203, Ailure to sport uo result 1n wnc[loed eh1cA lnc lode euepmt toa, tereinetlon, um el IOtlone or de6,,nt o: (Reee end leyuea of Ceepliy,•e yegl beet (N r eM IOmtLee or mnenegrl Shoreline Construction 1., P 0 Box 358 Woudinville, M. 98072 EOA Project No. '37-51-23908 -"" ".., 'eta^ , Project eeriptlon: -.r ._ S etel tel eort Moore of ReDloremt Ile. footro vino-tal ritr namer eee•r Cleni e. •, a /Tel Df of flee- Nit- a, Ael el rlt reDM �%oeRW'e I1ee• (I'p'1 *NY ttme Totalslew ,[ ndler. h �1ate - total te Ore 1ne Ons 0. nqr rtynd . Y/Ii 9 ae AD ore ne Ons 0. A . r T C Tr Au Tr AL �eDW ofliele a ore T / • Cote 91ene0 .ra me Mue6•r Bkpo- (lnelud• Ara cod•) 3�3);7r: (2061 486 0755 i f 1L1 P Tri-State Construction, ALL FEDERALLY t,V ,LVED CONTRACTS OF LME Inc, 1n ARPA OF Renton NO/E70M PLAN FOR MNn71 OFMar_ 1978 i - uPfny) Southwest Washinqr,n GOVLnAw T AGENCY CONIRACT NUMBFJI LDCA7I0N WtDUNT % C@RLEM, PROJECTED COINI2T!ON DATE Bconomic Development EDA/LPW Talbot Hill Pump 214,489.00 25 � • ,be r, 15i8 itt� Ministration 07-51-23908 Station } F ALL NDN-FmFAL CONTRACTS (ANVA n SUASODUENT 70 m1MSSISTED C*Wll"T) IN PLAN AREA MA AYOVE IUNM L4, "NAME"OP CONTRACT COIn7LALT M,~ LOCATION R AMOUNT I iangu TYD PROJECTW (*KFLETION DATE None • i t i j CITY a "KOM EDA-LPk PROGRAM 4:NORITY BUSINESS ENTERPRISE UTILIZATION REPORT sue_ MpNTyYEAR Mar. 1978 Project s EDA.'LFW 07-51-23908 Title Talbot Hi11 pump Station Contract W-as❑ e Prime Contractor Tri-State Construction Inc Minimum Dollar Am.ust Allocated or Contract) Minority Enterprise Now 1 Address Type of Mork Amount Paid IRS Number This Month Shoreline Construction Co. Installed watermain. P. O. Box 358 17 513 ot� Woodinville, WA. 98072 9i-os/473 7 i I � I � i I Subtotal This Report + I -7 a) y; ANQUot Paid - Prior Reports E -G— ,�v� Combined Total Payments s 17 523.06 ( �) ✓ (R Percentage of Contract) Prepared by: Arlene WhjtW rtli Date: 3-31-i8 Tit Is; payroll Clerk .....we..oun or vrxow S7AIEMENT OF COMPLIANCE • twaa.+w».,,v. aaa,oyt Da,r March 2-2, 1978 • e 1 1. FUR e"pn`.tl+ �°AS'rR(��-c] 4 a„nerrny,..•.. (i/That!pa. „super.- the paynrrn,of the Petwm empL.rd N Tri-Stara COnatogt6�_ion Inc 'the Talbot Hill --'r'•" ��y "°n Na:a, rt sa� ,hat donne the p'smil period:amarmtnn on en« SC.4sa,.of March I9 and r.d,i ;D '1 of MZSC�_ I471. all 1 t"C" emptoyrd Co .a+d Rro!rc, Aare been p.:d the fall seekit wanes earned, that no rebates he',hero or w:11 ta,made uiNm':,emh a.Ma,,,tly Iu or on tuhalf-1.ra Tri,, aCltate COE1atX.0 t1�1 _fmm the full weekt, amid Dy any r.aswaRsz a pvnve and that m.dtrJunm:..ban been made either drnvly a,frrdl,ecelf Mad the(oil sines.eam.d hr anti"esw other 1 a,Pxmas'tblr dedocuona n Re¢ulafona. Pan id d (29 CFR Sap , Al, awed hn the Serretan of L.bo, under Mc r.>n•tend A•:t a defined .ea amMJeE (I8 get gdt rid Seal IM, %Sat of,-. 76 St., 1%7. 10 D S C Sue),and d...ntud bile a: w+tw�olding s, BICA Ta_+rae Meth aT Aid a. sgpy �ta1 PapaiOn (iA) (21 a at 1. grolt'otM,wax under ribs coma.' there h to ne f I'oa •o e t 0r aDgve period are air. 'o am1 s umple•r• I. he wage ,<.for l'bMeren+into In, ca M ,, he,them a arc not lens , f the ." .for wane .errs Epna mod m an, ..bar h me..,i, a ia,f.hred min the ioaar t; ,hat the N.+artrahona xe:. fanh,hen•m.for each bbares a,mrahsmc raw lom,wuh the woh M performrd w(Ma 9 d ). nrmra'teaaa Toyed m the-hoar"nod an• dui) mputered m a bona fide apprt m�eahrp p,on, .neutered LaWr,or dm+aawh,yco p de�Y reecµni,eE Dy tit. of dppmntrrt.A.P and Trxmme. iJmred Starer D'.rMnent a Staten or if.mt ae[aboraed aeenry exnt.Ina%,.M,'rc «n,.Irsed with the H.,...of APpn%n,"n-Drp and Tfamrnµ ti,, (m That: d) WHERE FRINGE BITNEFIn ARE PAID TO APPROVED PLANS FVNOS.OR PROGRAMS X In sddu,un to the basic hourly ww rates paid to Each IaWrn or mecben,<i.srrd in rAr aborr refbr.•o,Cd pay rail. payment. of hmee henHih ax listed in the cantract hen been m sit[be mnfn br aPDmydav-pnNlnma fur the bereft of..,employ se, es tpt a nntrd in Srrnirm kr)below tb) WHERE FRINGE BENEFITS ARE PAID IN CA,g Ea%n Lah.ret ur mtchanio lewd m'her'ho"n•.ferese'd paymtt ha ,n an s torso pald.s A,ard.d on the peyml:.nantnot Ira,ibar,,hr sum R(ihb,pplre'bir beat.hav,t,wage mar pia.,hie anmnnt of Ma,egavrd frsner henefi,e as Ihnd m the eronaot.except as Gored en aectfnn I. l Iw1yw 't UCEPTIONS EaCOTION(CRAF I V_ Ee FLAWAr1ON e,.w.s v Arlene Whitworth, Payroll Clerk GCS �r Fm�.awJY i ,n a�LuafE +✓is .ca piwe C'.. wOe ^�L f..✓,.nI(.;p<uu Epr! O.Y.B.No.f!R$ee E nt Of[fTOer Tt 19M a�tb +u °ci.�e:R•.i:�N.o°.�.:r°..°�oF PLEASE READ ACCWPANYING INSTRUCTIONS ni...r«•:...rc»�..ab�...P.L.s�»R i«..tes. ta., •• [�o.e.r�r r BEFORE COYPLlT1XG ANY PART OF THIS FOR] �roe:r.L.wp,ro6 t,u.I. LOCAL PUBLIC TgPRS PAYROLL REPORTING FORM Prfdet A.- P,.Wt Lw~(CRY.N T..Co".3f41 PLCASE\•IT[RIIWERf UK[IRIS: 1 23456 .7890 -GWFL IM{rM►rf{oN Yf. [N►Ipfr't 1R/Fs. Pq PrWr[aW .'►pMl IINM Leq Ppnll PRWT NITN FALL►MNT►ER 00 TYPE Yn. Or. r' Enn."L"r!MIa r•Yev.Lev —_-- - PggllbduP•elr<r- DAGE Of PAGES y }r » y O•Mn.n.I EA VE NL AN\ Gress meant Grooa tRoum GC•eDaSo[ItMl eeseNcurn tY Lon Pen AtA,-.. MOu nw e4�5p_ yyyy( SOcnNl uSPrtrauu tY Occocaueo a cPne• AtCour{[I o e .cNe CM. Ner4a M,, amen a wortw v rrne{[rt{e(eDt D.y wre aY Prrn an[I ' NuaInD{rapKfna. f wF ZTL ■■ • - •u � �' 2 NlS µ y )• N 6p 1 f} fi N J ]1 µ µ t• la fR ff {t N en E t� S I { 77 1 ( YY S it r IS . nELI # Yt 71 IA Z! IS ( r INtEr D{I I.N w{p I.W taew{n eeylewa by Ml[I1E►ANt6 (Ct.rt w.t Nnet 'Ff i�5tiAt4 "cyi`E tile'tion TTC 111IL TO Ch W.MMmalm SyMM MW SMW#6 Diel9ir M.N Pwfw Pn MR lywrl'. 1 •C.k.w E,~Kc.nmlop al AA\itist ol9f Sbw1110Res[:>9 - l:]8 ?YO.Yted 1N.E. U.S.OMRWt11 fIG�up "rlgdd Wbitw rtFi MMrbN[w is tlfiertripl CYy,H{y.Yw,.11da've•, liashir_a•LCm 98')!)4 RwR B61S,119Y CaolJIn BME146 St ad . MIINEY aw(w 1 N9MIRS m,DC C'g AWaW Wit SELEMIOR[: Z}r$ T{Yi.N. MC~ Ant Cear IleRRrtd 4=.�757;'1 ! .nrew.x ww.nw wa_R ...-D„a�,.,F,�., :TATEMINT OF COMPLIANCE n••r•wr- r-slPr�. n. March_ 15. 1978 Arlene Whitworth Payroll Clerk - ' .,Pn:•,Par- - "T."YIw:YMIwc^•^' -t n •,n..-,. Tri-Sta-te Construction`Inca :he Ta l hpt Ai l l 1R@ dmnnp+fr q ,r �p :-y w• - .9th ,. March IY-yp mn.f 15Sh., March :..� Yl< FC xx.. n •'^i'i.FN o a°rd pmpea f,yxa bawl pored fM WIi +nYh iv• - - - - -a1Js enfiPr dtrcF•p nr rmhn.th V, -,mn bmAatl ,I°ud i= _9.tIItB Constr'�ct inc. ... wages eroed nr any uemm�.q.t,La:m dWn<.ronq ra... N_„ F-rvn .,der h. Pe Jam',onF.,•d<Im.M ash�•+•a• re _.. ... " •-.1 LAmr ItnJer•be CI tl A.tr.• anen]v.f PS &n • - .:IrnL.r. _.. _withholding & FICA Taxes _ Medical Aid & SqW.lemental peision (IS) 1B That An P+r Ib oth dn- . raYmeed•- 1<.ve�- 1,f f r-. •.,,'-- lkr tnm wAFn ne a for fal�en Mn, J lb•uv.an n.n t Mry,,eu' :t and oumplan. wa�vM<nn Am uu.+Twaee.l hehe..n ycl.Ihyt theH+nh•.aR na ae• lon ,hmwnmiw egr�]mM rc.nrnTC,h,,,Mcee le. i+h rM'n.H M ir'rinalrtpd Oil that my apDnnneb emhlexeJ Fn,h< au..f 4»T.J ue• dRly o- , r.-d w.Pz:er hdr.Ppngmaghlq q•ngnm n utervJ LIN..,k;r..P°h rt.��e p..n":Y .f.•nq e.e.n nr -br HYrv.m „f A%,r .<•ynlr. .nd rn,nlne. o^;t«e saM.owyai.,.nt hr Sle,,Wpanmml A Lahe. K^eY ea,ala m.5•Ytr u•r ry<.,rahrrd w,�h•he Om.ye I Apntrnrr'nhlD PmC Tr.unxny„41n,•.tl ,II IDIM: (A1 RIIFRE FRINGE HENFFITS ARE PAID 111 API•RO'�ED PLANM "'%In OR PR(XWAMS �[ fn uddlrt^h le ihC Nhu haurlY wx;P nur DArd la Ca•A lyh.'rer•� ^',f<'b..rt, Iixtwd N the yEvrYe nhRM'M ya]. 11. FRYmCnIa ni Otaq<MnelrYq x I-" to tI <1.&1t hyv,r 1 b. -.m171 M'made Ia apgreDnj.h Pn+gnmA fw the bnellr PI xu�h empto{eea. YgcePr It n,nd rA 4<-n>h h�.I bPlnn (bi "FRE FRINDE BENEFITS ARE PAID IN CASH .. �fi 1+bear er mechavc Baud rn 1hf glove nd.rev<d p.Vr,rlS naa Wn Dgtd Ax iMn'mMd l•A iM Maro4.nIC w.1{te.YP:nanl uEl D Am F^Amtnd keq•z I St L.VauA� EXCEPTION ICRAFi, "PLANATION t Arlene tshitwcrth, Payroll Clerk OY!Fp., NAM m c•w r II nH u.,.oo•.+.exv�rv�w�e��s PLEASE READ ACOOYPMYING INSTRUCTIONS BEFORE COMPLETING MY PART OF TRIS FOR 1. M4.«v.r b•.bubn•b 4w.r L.ee-0e4,S«,.fps.O•, w Ns;V.I. e4 1,T•4 f.C..L LOCAL PUBLIC FORKS PAYROLL REPORTING POW tiNetf S. r+eFU Lw Nlw.iCNY.•r T ..Cewb.U• M.EASE WRITE bumps UKE wit I _ ! 23456 ? 8q0 r T MTN►AA.L FERRY"N BR TYrE rgmN RrrM LHi r,n•fi Y l rrMM,l helM F<_ EgbswY IRS Ra. M D E,Wf E. "L"d Mn n pu.Lear Pn.oIf 4.e+.r,wl_ PAGE OE— PAGES L EA vE BL ANK f t n 01.11 4 p f FHM Gr...Nreunl rer.• 4ccuD, Oat ACW61 HmN on rnv. Sfi Ocap, PIT Ac W.I •,mN cn pr<� S,el Me pa W UH enH nepn mu prslHl uHr Y Seo,i Sa<umv upn Pen neon Ui,pNf•ct <Ne cep. torte, f<C W .r pieYN R g Nuw<e� CNe CNe YerYN fer qu <H.4 Y— HY 1,nN p,Y Hue< ,bYrp � >f g Rw Ii 1 / A S \ IF I 1 R 22 I _ 2) !A .TS 10-11 x I1 - t: - n _ 21 --- --- ------ :s 31 u re D•Y Tee. �,WmH�rN+e,ps.e ore<mc,:;aa FM wrz4—�tita Contttsvet ire: wLTG QMt.IKIsM,:A lTOw rl IM OirnMu BATE PRNPAREB: ) 17 P ,o•. U S 00 O,t*I c AIFMIMMM F,w•A Me•p PrePeHpi 11•„fY Ce•FwM ' sl.eN ANN..�"..5.� i SO 'y�u4 _1 '. Rom, On 15,KI W C M,F Bi15,wu CEF/NE PIy. ,r1Mno whltvnr _n Wec.Fwfw f•,nt�hNanpf C,ry,sur,zit Hc`leatse svaahiTNSton 9Oil04 1�Sy.wl Lw,MMiH A~.R.E. a�rrw 3046 RiwA,A55 ;2570 r,smAlw,D.D.am ArM 4l, RIR�•• �.3:'. ' T<N,Nwe Np.M swYU Art Ce,e 1 rm u - Wds 0 1 lIftm PAGE OF PAGES i ■ ieii�ri 0 ': _ °MI//� !Iu■ s■ I ■ou■s` iio■■ssI■■ o■ ■■/ ■ NON N=! ■oE ■■■ ■ !■I■I/ ■s ■ ■■■/ sonMEMO jj � monsoon ■ ! � /�masm >©Nn / �■ ■■ /! / W ■■■ ■ ■■NNEI !■■u■ ■ u■■■Ell !■ ■ ■■■■■ ■moll!S ■ ■ ■=�■ ■■■ =■u■I ■ MINE SIEMENS � ■ ■■■■ ■m ■ � ! i = iiiiisi � �■i�l� ' mii ii ■ �■ m ■�i � o = E = l ' m111 s iI I ONES i i i/o■!E■■!!I■■■■■■■ ■■■ Iu ■ ■ ■■■m■■ iI E ■■ ■/■■moss ■■■■ 1- on MEN ■■■■!E ■■ ■ ■■ ■E ■o ■ Ins■■ ■ ■■/I■■■Ion ■ ■ an isoms son pass MEN No 0 smems mass on Iml no lson ii _ OM.R.Na.fiR,Na[a na WernAar 3t 1971 N[OJM �Pa uanR wEN ourr��n.Nw.{ PLEASE READ ACWNPAXYlNG:XSTRUCTIONS ..L I05;P.L.14447,T.J.1,cn.L LOCAL PUBLIC WORKS PAYROLL REPORTING FORM BEFORE COMPLETING AA'Y PART OF TNIS PnR 11o1a,1 Naa: ho!o[t SACMIa:(clq,R T.f+,I lyl RatW PLEASE WRITE NUWNERS LIKE TMIS: =nLnn, Kino, Washlrntar, 1234567890 USE MLY IoaRa haasl M. EyrYa91R3 Nf. Pa EREa[ ►aYrMl Radar I.A.►mvM l /RMIT WITH MALL MOT PEN OR TTP[ W, ric Enr..•'L"If M;a I.wu.La.• Pur,.I ro.ar.W(l" PAGE OE PAGES n n v >r DArn..1 o EAVE lLANK --- Grofs anoint S Grins sALunt U,I. Pa] ...ed Actuu .ama4 Lrl a reexf X W,tla _ Y SPUD hcwrh 8 - uupa PaY A[tuaImn Por .urs Mn Crola<t pu,. =E Sp<i NuADerr�lY bon no4 Lwq tint propCl . VCOL, Ur'[ f.,Inrs uner'b q E tlaan' R V.r a•�0a Y n plOv,4 �- t F F! aOla cOLn nork,4 for M. -S _ E pq p<rma C 'E pIaYW E t k . J 3] 4 • !r {a f' ' 6r 6} {f i6 J ff Y ,. Sr 1, Op {1 {1 2 , n 7 i 11 f ; 1 2 2 F4 9 I ° 1 N & l i t N A _ Y 1 is E ` 1 r, > E M _ . 1S S !r ^ r +- to E 71 rf I7 s r 6n r q Y 2I 7 o1An r II Ef I I I I 1t 23 S s N 25 •11 g 12 17 13 2E IA 29 IS m SLFN DM Yoar GLplayaf Ir{ta amw.re RfylcTa M EAtt MEPMLO: J ig (o«n«,] Maw :hn.•el in. I'nffe r.r}r^inn rn RAIL TO: C!i[L M ar np.N tIRrMia 374MsaM SEnia[DITI[yR me►Pman P ,R.,AoL ( C Acw SVan ALLnaa_ P CLSESK lrp ERNMICDMkMRaI ASwinIMlMla Yuri :a7 s'.-; L s Da►WtaSAM omomma ':sraay.,w ILmura n„Ms dry,snn,TIP Midi pg(:.e •ra a?n 7z RORs L MW wS CrWWa BMS, Ana G{a Ra{dar l was io aM D.C.METE[AwEN1.N.W. TEi.E►NN116 - ' 1 T,NpIbr,Na.of CWNact: Ara CAekC 3nF �NwrS^a -ry7SG WSlsmpro.D.C.87f wCnrw.oc ou..nn +.9uwP„eo+awxpw . STATEMENT OF COMPLIANCE ,I." March S. 1978 • I._ Arlene Whitworth payroll ClerIS 111 That 1 11u1 on xup."Irm the pii,rnem of he Per.unx IPri-State Construction, Inc,_ the Talbot Hill Priem Sta. ;lhal during Me Parrott period r,anmenung tan th. .iv. o Maf-nh �9nn rNaeewa o�.1w.arn 19 -ay and eredir,the" tn.y of Ms�Pnh 1929. all parwrts erployed on artd pM)ect bare been pr•J the lull weekly w.gen eaorme.that nn reforms have been or Will M made either d,rertb,or Indirectly to.,r on bW,ill of said Sri_ RLEI e[f�n Tnn_ from it.full weeW,Wages---A Fv ury penwon and that ro,dedualmns h.ve been made either dlrectti or uW,rnv,h love h,full wvges earned by wit'pol,v,, Inrn lhau pcee,aalbh .tedwrl-ro.,defined is Posit...... Pan 3(ze CFR Sabu,le A). i .ed bi the Sermm of Lab.:under the Copeland Act. as sounded lM Star 9g6 bl Star HIS. Star %7.70 Star 357, SO V ta S C 1:'So), and described heb:W' Withholding eFlCTaxes Medical Aid & copy lgmgnl Pena+on I41 _ (D That any pw,,Jhi thrmtse under this cnnlracl m,fulmd I, I- .udw✓,r•G Fri the above µrind on,auriscrt and mmptrm; th.I the W,Be rate,for latw:erso, neekaaca co amid themrn e Wage ram,leap than the .NFlnvbl. Wa ramp con riumd m .m Wage deworrowty.mcurpormad lIn.Me,ra twrLL Mat the r1wsvl...unns am funh Miners fin eacb lad,mr,or axvhanlr no fore,with the —A he performed (3) That any aPpmnt. as ee:pioved [n lire ad,ve Per arc duly reR ammrt in a ,o, fide."ne.,ee.h,p program rrgi.m ed -,th a State apprcnr,ve,hip ,Benny recoanraed by Me Doman of APpmntle.h:p and Trion. . United Stales D.panwea,al lade,or,f re wch ri e.,,n and romwev eatxn in.Srale,am mVismmd with the Hereau of Api"mnin onoup and Training,Veined State.D.Panmen,„1 Labo' ,A) Thee (pi 1'HF.RE FRINGE BENEFITS A1:E PAID TO APPPU\TD PLANS k'VNU5.OR PROGRAMS 7('- In eddihm,to the basin hvorly ware ism.Paid lc.,art,laborer nit nerhamc b.e-ed m the above refe.."oil pay roll payments of fringe benefnf an listed in the contract have Lean or will bv.made to ai rorin am pon ams hit the berwGl of such empinyeea. e.cml as..led a Sec,-.9(v,below (A, WHERE FRINGE BENEFITS ARE PAID IN CASH Each 1 adorer or ren hank listed ,n the alcove ovv nmwred parmll has anee paid as I,Mioewd on Me payroll. no .It not less than tim x of the appLaafilr hears ncmrli w ra plus the.mount of the a m9uited fnnC� betuf•..a listed in the onu.Ll. ecepr as note]In nedlnn bv,bre elmr (n FXCEPTIONS EECEFTION CRAFT) Eky_ANATION Arlene Whitworth. pavpol 1 •I n r.Jv O r pa sec,,. Ira,raft t»a[C•..PnG 171. o.c.,..�.;:_i=scot c.. o, aca sac �r r .;'I .,. vac-o..r oe or »a .,, ,r . . , F.rw Mw•Bsh tan., .va<»ase rota...m+.crc. raou r»a xaa,oe pot�+,aN rx O.w.N x•.41*046 Ea .'D•amMr 11 1979 =•f•F09M Uo`.p[PARlx[x,�OeyCOwa[NCpN Th,.•..«[:[..I 'i.a fr lw.P.L.14-Mq)....fe), IeA '� .c.....c Ym.rf.. . PLEASE READ ACCOMPANYING INSTRUCTIONS w Y3;P.L. 477.nn.i,CA,I. LOCAL PUBLIC WORKS PAYROLL REPORTING FORM EFORE CORPLEJTRD ANY PART OF JTRS FnR Prelwt None: mr•Lct I.&tlw:(Clq.a T••II.O•eaty.MIKE -�- PLEASE WRITE PIONEERS LIRE THIS: 1 2345678gO OUT USE ONLY FN•ral Pf•Iwl no. E"Iere".IRS Re. IY PMIN E.IW Pg ll■eRNP L.rt P, boPININT MTN HALL:'OW T PEN OR TYPEa wp Or rl. 1 j I I I E�[....L..;r m;.,.ro.•L•[• PAGE PAGES 0. a !*. �L Pqo !I h.M�.Poi. •_ c �e A ). N (OrM..m LEAVE IL AIIR -- --- Cm„em•Nf Ott.ps- P• Actual eam•eN We•ha Gm.a.waYnl _ ,RNh. w SPCI•r Secunty Y Occnpe Pay ALluel UYN N NYxE.' bN Pol ppme NU ll.pct PNv. rp SYU Munpa ntY UOn erme Repra M.protrt e LN[ Co. MorY[E I9r th Yn A. YlI[m pay"'..e plfy.a € r Lea• ma. .an•e .y NIe • Z _ _ p r P•rrPa �E 0111.d g i� N b [I •! be N 1 I 4 44 2t 9 1 O C O y 1J 3 '1 1 1431641 JOIS I, 7 7 9 M N Y P l Il 1 - ' , _ 1 5 y c 1 16 6 ° T 12 N 7 w i 19 _ s J 1 6 1 6 n 7 2 N I° N '' 21 6 ? 2 J '�7 ! 2 2 Q 0 R h Y 22 i 3 5 E 1 1 6 1 Cr F O in, N N Y 11 I ? 5 e > Y I1 F I 1 011,1 r, x N w 2/ U 25 15 26 I 2I 52 21 — t 11 tp — f 1 15 M Nap pay Y• 1eWeyw,hew Abe.w•eee"NY SAOreTSnt oOs trUCLIOf CO.WAri atE►BREW: i :a K2P (p.rh w.1 x•.y RAIL TO, piN,NM[RNiw Sr9 W Sprias Diyip{PR MAIN p P .m pr perwE RAW WNErt AWfIpIrtMn(�CwbNts stYp Aaanu K P ^ FOX i•iP cwleNk D•w U.S.DepwbEet p Cpwe•la Yrlr ek1 MewZ. .aYImY u'lot I n Rowe Di15,Main CaAYra EN Ne;w. MYw.I E , elty.suu,zip__ ko(.l nyl Ile. MA .*M. 7z E. ris.tPNwE )zr rYw T 9rr di ll.min,D.C. ap Aerw,Rl. . - •MpllPl,xp Pl Ow4ct p[p ReRWe[,��:,'_ W PRIME CONTRACTOR NAME AND ADDRESS Rentun, WA EDENTIRCA TION Of WORK .Name of ba{du�R and Nelu.a of WorEl CITY AND STAY SUBCONTRACTOR Shoreline Construction Co. W-450 Talbot Hill Pump Station d W-251 Rolling Hills Tie Line P O Box 358 PAYROLL PERIOD GOV'T CONTRACT NO EDA/LPW 07-51-V908 doodinville, WA 98072 BEGINNING 3/2/7e AND ENDING 3/8/78 I„rn/t rFn fLo n/ l.dr, ,r,r./rlvt rlr .!n,/, ,ni,.n r /m rr / r,!• L,lvr, m ,,.pmn nrri rtv uor[ /r 7)Jv,jmrr..! 'T/`i. 5EGNA'"'RE '.olo, lit.ei TITLE Bkpr DAILY HOURS TOTAL HOURLY TOTAL Sxyl I cn om. M.d: .1 TAW IOTA- NAME OF EMPLOYEE TRADE HOURS RATF IAY bw,ih T•, Aid D.du[c.,m IAiO 5 6 7 R 2 3 s4 r„ W;gMM Will lam 1.lffrig Super .17 Sr,.; Alr. - • -�:._'g' 8 - 16 13.00 208.00 13.52 40.00 1.89 5558 g ana 152.42__ r .17 _ -- 0533 42 4287 Oper $I,,; T-- - - _ - " 8 ' 8' - 16 12.23 195.6P 12.72 17.50 1.89 3128 163.40• o.,,- 1 Johnnie Bear Oiler sn.;yAT nm. - - - - 8' 8 ' 16 1LiRz94 177.92 11.56 11.50 1..89 25.12 152,80 Robbie Walters ' ac Pi pel ayer sf,.:RM rn,. _ _ _ - 8 ' 8 16 10.17 162.72 10.58 14.90 1.89 31.54 131.18 o..'r'm. .I7 Uac. Duane Glick Pi pelayer 0..1... 8 4. 8 Douglasu u o..,f:m. - _ ' ' ' _ 16 9.42 150.72 9.80 21.60 1.89 37.46 113.26 - -P537 70 5381 Laborer Sn. .14 RAr Dm. _ { - _ ' 8 5 - _ 13 8.94 116.22 7.55 14.40 1,54 23. 92 59 i s..yel cm. - crofi.N _ Se.WM TIm. t On.em. NniRM Tim. SM.ipM inn. _� �. MnIgM T:m. r - O.MI.. sf,.HMT„ i O.0i. _ sn.; f nm. Ov,Hin, +- , SI,.NM T;.. 1 TOTAL sOw EPMI Y.1 pFwM1YCNt Oa COYYFMCC 4o.1i•A:M: r uF+.*.ry azowo.,a Ptvtr^r�e�• ao•a;w,-Nine. AParme F11.1 Iene V. F-. STATEMENT OF COMPLIANCE M.LUM't:wa w erwrrr JN) Dire March 14, 1978 1, Yuri Suzuki Bookkeeper awe ,wtn ---- do hem' =um: 1;Th.,I pay ur nupemat lies Pee.m,of th.per.n.,e.rmyee h..Sfiorel me Construeti on Co. �p ,SDA/LP4 07-51-23908 .er.r,.. yytYe m ;in.,derv,,the.peroll perwd cow.enc.,On th.2—day nt larch . I9 76and end. '•!.O day of I�d rCh 19 78..11 persons Omployed on.aid proleyt Ni v bern peed Mt fail e IY rages♦erred,that no renews hire bees or.,If he..de mUer di 11, Or indirmtly to air On hNrall of said Shoreline-Construction Co. teen Me loll wmhly an.....ad by any Panes and die no deduearen.h... been made todme dvecHl Or M&mrdy how Me fall.learn ete ed b1.11 Person, othm Man pariamothle dedprtrows wa eefly,d in RegNles.na, Pan d (A CFR Sabhl:. A). ,.sued by the $mmlary Of Labot under the Copeland Art, as anesdad(a Sle 949.63 Scat 12,,'.2 UIL 967;TS$tat. S`;ad U.S.C. 276y), and dewmtbad below. (2)The my p.ymll,.,herder tinder-h,.cones-, re9ulred to be.uhnUtad by the oboe.Period ea cone.a and cowplete; that Me Nate rates la l.b.aye or.sebmm.(.sledm,aPprentmea and taNuwes)emlmntd there.are sat:e s Man the xMih. 1 r.his wall 1.1.9 yontained m any rage demr.mahm..'.'*led ism the rontracl, that the cle,ef.e,on.set IotM them. 10,earn Iexemr or n.ueh.nv I�ncludtn,appmrh.n and mince,I..Nen wlh the wodi fir pedome-d. ('I That anv appranit.rs employed,n Me.hove prerud are duly earstesed indlviM*Ilv under a bona fide apprenttreah,p pre- tram raanteO d with a Slate apPI.nt.e!b,p adarmry mcoXeI d by the Burteu of Apterntic*%hip and Traimag,United Bees artment OI Lelia,Or if no Own mcopnlsed a,ent,exists in a Bale.arc mFemed with Me norm of AppronRryultp and Minns.U.,tad Bee,Depanwee.1 Labot. (al That my series a.Pioled in the above period am haft fide trainees employed Pursuant m. aoeei.PMosed by Me U.S Dfeannen,�t Lest.Manporer Adwimaisetpp, Brimse of Appmir. sh,p and Tm,o.., (S)The- e WERE FRINGE BENEFITS ARE PAID To APPROVED PLANS. FUNDS OR PROGRAMS —Xi In sWrhyn to On. bao„ h'e111..R ale. paid 1.each let,.,or Irrchmlt.iricludl.g aepte h,,and heir, heed In Me abler,mfer.m.d Martel.resents o1 fringe benefits as I,vmd In the ronme l lime been of will br made to wetmprime pmea.g NO the benefit of mob employees..acept as noted.Seehm Sly)Won. !o WERF FRINGE BENEFITS ARE PAID IN CASH .� Each lab,ar or mmhwmr Undud,ng asprentite said tramm)list"in Me shore mlemared Pamol:has limn paid x Indiorad m the resell, m anneal n.t I... Mm Me wow of Me wpphaably h..,, hourly wsay at.flux the ---1 ail Me m,.lmd Deng banef 1.a,Immd In the cmerai t,except as n.,ad to See,run 5(.a brinN. /EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION TOTAL NUMBER OF EMPLOYEES TOTAI.NUMBER OF MANHOVR$ EMPLOYED THI-,REPORTING PERIOD 6 WORKED THIS RFWIRTING PERIOD 93 ~ Yu i Sulukt, Bkpr r --=r "- > rx - .. r. _ . a(re.EPIQ rcowovi�ocvi�oa c6�CwMM[W wit (AIR No 11.R:NI ltPp-ral F.pima 7m'10.191e STATEMENT OF COMPLIANCE Date March 3, 1978 —...m., L Yur.--i Suuki , _ m,�kk,e�P�pr doeer.eT.t.tc .roar (1)Th.t i Pat or auperrtar tb pamrt of Gm pmwa empBbyed DT SAOrtI ifiC Construction Co. pp \ EGAAPW 07-51-23908 .m tit. Me :Met emMt Me P,rrou p n mr. oa.om .Ma ona M.�`r of tQ�rMarY w March 19 78.na emlr'•he_deT of 19 78,JI pereat,emplo➢ed w and pralact Map ban p.td Me tdt 'eakly reatea tamed,Mu no-betas he,.been or e111 be made e,Mer daeItIT or mdlmctly to or m behalf of,ud Sh reline mW.�CoBSYrOCi: Mrmli Wl Co. f-®me%U weekly w.pe ire-ed bT utT pmro w Me,et no dedoelorta"v e \w ,m been mede,elt6p thhertly or Mdl.erly from Ma AD eaaee eemed by any Pare-r,-Me,rhw yermisuble deductions its defined to Raelebma,Part 3 IN CFR Sabtllle A),\steed by Me Secmlary of L.bu,order Use Copeland Ar,,.a amended(a Star %&63 feat. 109,71 feel.%.;76 fiat. 35%40 U,S.C.I76c),and aeeerihed below; ;2)Th., a, o.y-11.mberrMWe order Mt.conmact -aired ,e he auDmitled for the above pMod art correct Wed e.mPlere: Mr Me-ate-tea fro 6ho♦re or me<h.o4.(rndeynt.pp,rucee wd tram...)coremed har.bt are not I...Men the wit. --bit w.te retire I..I...d In.n,aaa• de,eemao.Da mcee boafea -to Me contr.tl..%.I M.claa.fte time.eat forts der. to fo,each laborer n.me•heatc(mcluetot epp-moue wd He�ne,)ennform troth the rand,be Pe,foma,& (3)Thu wT +wrm,r<es ear lo,.d r Me ebo,, Period ere duly eerster<d iadir,dually mode+a hone f,d.aw"nticesn' ram reremred wt'A a Slate eppeenttcetbip strut mcoanrsed by Me B " Plateau of APmentiuhtp and Training. Vatted$a ea Dap rtmr\ of Labor'of d no atxA rerort(nad""''alga,e a Stet', at, orl.l.red w1M Mr B..,f APpmmtceah!p wa 7.iewt.Vamd Sue,D"."vent of Labor. (41 That wy ,at....empi,yed to Me.bee.period are boo. 1,4, heroes,employed Y6IN.n1 toe W.V.appoved by Ma U.5 Depeelm,rm of Labor,NWepower Admmi.teNton,Boar..of Apy.<nnr<,hiP eed TharrrMW IS)Thee: Or)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS Io aedfbmr to Me bea' nouNy,retie -tee paid to each leboter m mechwig loeludtna sperm¢.and Harare. hued re Me above-fe aee.d Payed!.peyman-of tritiWe benefit...Stated to the cwvau,nave her m will be made 1.w oo'.tMR P-reme for Me breefil of a•ub erploraa.,esc"r ire noted M sr"; ,5(0 b<loa. 'b)WHERE FRINGE BENEFITS ARE PAID IN CASH Each labare.or mWehamc obn Drd,e.apprentice and H.,..)Iward-Me above tdereeced pe}nfll has hem Pud ea"date'"r Me PamH,ap amount lot feel Mae Me tom of dl.ppht .bl. bash. bomly ante rue Plus Me amount'I Me-yuwed fnnWe banefo-as He'd to the contrut.-at"'..rcrted M S'e,ron 5(:)before, Iq ETCEPTIONS Ey.CEPT10h tcRAF T) EXRAMATbN_ eD..au TOTAL NUMBER OF EMPLOYEES TOTAL NUMBER OF MANHOVRS EMPLOYED THIS REPORTING PERIOD WORKED THIS F nORTING PERIOD e ay �un _-- uecow oc zsoy.ru _ Renton, NA PRItAE CONTRACTOR NAME AND ADDRESS IDENTIFICATION OF WORK ',n.me of ewidmg and Nat.,.of Wo,kl CITY AND STATE e35�ons W-450 Talbot Hi11 Pump Station 8 W } Line SUB CONTRACTOR Cohgrilin trUCtlOn CO. CONTRACT Rolling Hills Tie 0A PAYROLL PERIOD GOV'i RACT NO EDA/LPN 07-51-251-23908 Woodinville, WA 98072 BEGINNING 2123178 AND ENDING 3/1/78 /rMifP JIx.J Jbu pnvbl/n ,„ ,..r .u,J.nrnpAa.. rb.,1 dx'n;(Rr r.dn .w./.rand In rnu .or v>1 In Iltw 1/r'Vd",_14 r.rl„ ,,.ut.u.r..(m Ilr ....T, .lnn nmrdliprt {rump o�J/+^,fiYAgilrf o/[ela,..in,(Ih.,l rh, ,Grw/n.rtmu. I. /o"" ,1,/,11, I ford,J., ,nJ, ].dw¢r nr urn.b,uu, .ou uwi / pJm u, i TITLE Bkpr 77 DA'LY HOURS TOTAL HOURLY TOTAL ( 5xb1 loam. M.dlu1 iebl NAME Di EMPLOYEE �!-TRwDE T� �.MT �F W HOURS RATE PAY Snurip T.. PAID Aid D.d.e+'w•: T,. wi,hE.Id 23 24 25 26 27 28 1 am i rig-- - ownh. . 42 7510 Super. s,..i Mnm. - - - - 8 8 13.00 104.00 6.29 40.00 .08 47.32 56.68 AM nn a ear °••"im. 08 504 36 8362 Oiler sn« MTime - - - -,8 8 11.12 88.96 5.38 19.60 .G8 ac.95 2.01 62.7 o y a ters o•."im. 531 48 2289 Pi ela er st,.igh, - - -�8 - 8 10.17 81.36 4.92 21.00 .95 28.95 nm. 52.41 uane c •.,,im. 501 64 8753 Pi ela er 5b,:gMnm. - - - 8 8 9.42 75.36 4.56 23.20 .95 30.79 44.57 _ A,.;ghE To. 5k«qht T:mq $b,i9h1 tm. $enigheT C 0..,6m. . 3,r.igM Tl�q 5".igh,raw MuigM Lm. 'f 5nngh,Tr t O,.i'm $Ir.igM nm, $b.igM tim, t 51M111„Tim. iCtn_ 1 � w:aa anP noaw Prvuw., STATEMENT OF COMP LIANCL rSal N,.one R N.Rloo.l care fig[, 1. 1978 0 t Ari one Yhi ofo h Pa so7,i ark do her gry crate: ra..e •t nanuon nnrr —..— _ _�"iT 3� "�a.��,11 Thu 1 PeY or saber.u<the pavmen: .1 the Poraene rmpl.ged by �y_al_1+te Construction Inc.on es Hi the Ts h n 11 Push ; that dunnP ehe P.1en11 Sta. M—� Feb. _ Deno,.oromenemg n.the fIS'.;.f TTGG (P Irdinaaa.. erYl tgAy arW ending tha��liM,day of March jq 7 yyl peraona —11-IIJ en ward Pmmot have been purdthe foil a tekly --Re—eomed. 'hot rtn rebrtea have been er vA1 W made other don,11,or hrdmly ier to n be on half of aid fti— r1_tat��construction IRS tmm the(ul: wmrkle on-ea--hood by one Pennn aM Ill.'no .�n h deducne ave --Sea been madn elther drme111 rlmine,it, Irum the lull nnµee earned bl onl Perron. In,,than Dennl.,dd•detlw tans.n defim i m Reaulallons. Po< I I ru CFR SWIM, AI maed In the Sae„ran •f LaWI under the CnlmlanJ A.:, an amendel tAS S,.I 948 63 Stat 109, 72 Sia. W . ;n Star A17,ad D S P 2cn1, and dosorbed Wow: Nithholdin4 & FICA Taxes Medical Aid & Supplanental Penaion ( ) r (2) That env Paylells uthorwbe under thfa oohnact found trr to aubma:ea far the"pure pere.W am cnrren aM nm,Plem; that the waaa hotq fet Iahromn ar Inn hdn(aa...tuned thorem ve am :e.s lhcn the aWh,abl. ruo, rates contained w ant w"rce datemnnation wve,aerted into the eoateact; that III-clasarticumna aer fonh then.for each laborer or ewahon.c< I.—with the warn he paafrm ued u^ (3) That-") aPVmnncea employed m the uWve Penod are duly musmo-d in bona Yufa allDnnnceshtP Pr'+Faro reamwraa w b a State a-.eil acesbl0 aaedov remanlsoJ JF Iha Dole.. of Apprennc>sit, and Tr.,o on, Un.ned Sratac D.Pamm�w of Lw ..ol.or If u o,nh recoanned aaencv ex.ata in•Srate. are maistered ant,the cores.+,f A,.nennc eae.p and TmininR, In.,, 9mma Depanmrnt of LaWr (d) That: Ia) '➢ hRP FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS X In-de""'Ia the!hall'hourly wage rates Paid a each lat,orer or mach"nb Baled m the ah.ee mfemneed P.v- m11, pavmenls of Gina.baneflfs An Irate, in the ennmcr here been nr.,It be made m approimate p"nono for the bone!" of such emplaveM, except an noted In Seeti-n J(ar holuw (b) UHERE FRINGE BENEFITS ARE PAID IN CASH E"M L.Wmr or meah..ic Ibted in the anove referenced payroll hex been PaW an rru4cared oe the payroll an aanunt trot loan than the gum of the aWlwaDie haerc hourly wane rote plug be anho" ,f the required InnW benefits as"at"it the coonoM eacapt as aotod in anouon if4 beaow Ic) EXCEPTIONS EXCEPTIQN(CRAFT) EXPLANATION I Fzlene Whitworth, Payroll Clerk 1 OY.N.N•.ItR A na Da.W Si ISM •^[b SH u.x e[naRTNur os rrnlr[Ilcy PLEASE REAL ACCOMPANYING INSTROCTIONS Ty„ ..+«r....L..u.a n.:.^,P.L.•bMa,f....IN,101. B£FORF.COMPLETING MY PART OF lY!(S TOR r ms;P L.+xaa TM.I,CL.I. LOCAL PUBLIC MORNS PAYROLL REPORTR/G POW hN•[I N•wc hN«!L«NI«:ICH,,w Taw.hNr.slow PLEASt WRITt*W 10%LIRE IRIS: 1 23456 ? 8V "WIT MTN BALL MINT PEN OR TYPE USE NLY f{NrN hp«t Mx LMMYar'a IRS Na. W Pw�[MN r hSlw ReW LNI PgrNl — L E..ro"L' Urnb:a>ev.Lmr _ LEAVE - PAGE _._.. ._OF__A PAGES L.1�.iL r> xr aY H OrA...u.LEA VE SC BLANR cre»anew! Q Grou ampnnt Cc<uw, P•Y Actual WM[«. E€ Raek> _ Sp<nl 5•cunl Occcpa- P{Y ACIWI a•rnN pr: 1W. I Spual f[cmi!Y tlpn PNI nern tnn Dn�Rc! Dn.. ^ =b Y bN nN ANeI Inn Drpl•c! _ ... P ij■ Runb• Narna•r v.nm. cove vaa war4A ter mn cN• CN• NDIn•D m Un le e0 { pp P•Y p•n•a WeYN ee pav pYrrN = �6 D Y p z't R P PW /W 3 {Y Y Y !1 H N N l [{ N J T p as {I >a N tLj •'r N t / M -t- 2 ' S 2l t ) 22 S 20 It 20 II 26 1 I { to IS 2! lS � INnM O{Y YeW 'ch-4«.IntN Np«an ewpl«NM c COnstructiOn, Tn.. DATt PWARE@ !n..n^...I N. "hi rate __ BAIL t0: ChL 'D DPNIIGtNAat 40"1"W UHhiDR b NMCNn h{PNM AWT CNrww ISbM ANnea 459 - 108 nVwnoe 5.2• U.s.Oa►MNof L{RRalu Arlene 1[21itMOEtOS a•aa«eae>w ro«br ""Vt ..l ievue, Staahington 38�J'J4 Raw Bits.Wle CtarrN B14. crry.wr.n > R u w CNSt14RN AYaO R.R. R~w Wre« T•I•yr«a No NGnna Aw GY 2'),'a Rlera45i_ 7570 tNAwObn,D.C.ADO Tta/PRNL• 30F - �•ae.rr.e=•«•••+> -hl (4b STAMiARD FORM - 15 - Nepo rt L,� Yerlod MONTn.t dr. +c. IMAM. Veer) �. 1976) LT1:IL.Iloa teoNT prueribd by the Dept. of Labor (00epl IS.. revere* for Y....v et 3.ua11 - 1'his report is required 6y Executive Order 11146, Sectic., M. Failure to report can result In unctions which include suspension, teresir.at:,r., cancellations or deoat nt ) Tot (na.a and ladatida of Cempllanee yeaq) Proe: (seas emd iodation Of *astfaotorl Civil Rights Division Tri—Stat,- Construction, Inc. economic Development Achnin stration 959 - 10r. ,Avenue N.H. 1700 westlake Avenue vu,. Washington 98004 Seattle, Washington 98109 1P City of Renton EDA Project No. j_ z Pro]ee`tt aorlptIon'. T.in.ot rl elno- Tote. tal *Vita sour* or earloy.ent (des foopnb) rlt7 outer oar c1uLL ►. a. ♦ Ar of of of t ico- • Nie- •r� ♦N en/ tal total minor it tapby compare-9 dome Mi.) Tn do irons 'rota blew wnla r,.1. Yec itic b- 1mDlo)- •*e A 1„nd 1• r/h ae• Tri-State Constr- uction, Inc. Pr-• Tr II Same hrs r ruc "amv )riv 1 f rrP Same ter 1 7, C i Tr y T^ C I AD I Tr 1 f --j I � Tr :aaApany offiti, 'o (yrL r en a rate 3141ed . aphuM MusD•r 1444*4oE (Inolude area cod*1 Arlene Whitworth Aus: , z r. nj reb. 2e 197e ('Io, 4i5-2570 401 Tri-State Construction, ALL FEDERALLY INVOLVED CONI ACTS OF MEIno. IN AREA OF _Re n tOn MOMETOW PLAN FOR MONM OF Feb_ 1978 O0 ny) Southwest Washington GOVERMENT AGENCY CONTRACT NUMBER LOCATION fAMDUNT Z U P!.SPED PPO•ECIED COMPLETION DAM Economic Development EDA/LPW Talbot Hill Pump 214,489.00 15 -,CtOber, 19-P 0 inistration 07-51-23908 Station ALL NON-FZDLAAL COMIRALTS (AWALIED SUBSEQUENT M EDA-ASSISTED CONTRACT) IN PLAN AREA FOR ABOVE MLMM "YAM-"OF l.O!ITRACT COMILACT WMER LOCAMON f AMOUNT S COILPII,TED pROJECTEII CgCLLTLON HATE one CITY OF kE.\IQ.N EOA-LPA PkaAAM 41WRITY bUSIRESS ERTFRPRISE UTILI:AT10k REPORT sue_ NOWTH/YEAR Feb- 1978 Pro)ect a EOA/i.PW 07-51-23908 TYtle Tzthot Hill Pump Station Contract W-450 (CAC. e ) Prt■ Contractor mri-c_tdte Conetruc*ion Inc Minimum Dollar Amount Allacsted - f (+ _\ of Contract) Minority Enterprise Amount f°ald ' NAme b Address Type of Rork This Mond` Y IRS Weber none I i 1 I 1 i I I i I i Subtotal 'rhls Aepurt f Amount Paid - Prior keports f Combined Total VAyments (6 Percentese oY Contract) _, Arlen e• Whitworth ✓ate: 46-78 Payroll Cl.e�k T w�.e awP.ouw wetnbw STATEMENT OF COMPLIANCE N:.�•.Nu�e.,r Ir Rr911 Dat. `Feb:22, 1978 • • l._ Are , W1li Fth _. PA1Frr�r.1 Cl er1s ao bv„'b, .arr �n vim., --- .; f11 TM t P„ or.aP<•v\e the wYmmt„t m.1•ers.,,,cowl.•,rd 1..,!ne Talbot �Hill TfIi—SYaC on rnet ion Inc on (R.l k... , .thin'b"'" nempe,.d. nnnnemeon m<16 *of Feb. 19ZC 19� all peraone emp eC on u lovld prole y nave been pouf the ,Oil weekly w.Ae.famed.toff no rebase have been M wr1:be made girth'dueGly m tMrrectly In or on henalf Of..,it Trite IDc foam tho bull epnatLvctlon week!,xw n a gea a\med by..I Pentond llim an dedne!IORZ hive Statewrm. been med<either dtrib"J,ee nibbu,ty Iro be full ee"S eamed S, &ey Pfreon• Ofirer .than perrh,..lble dedbchon\as defied Ih RnXWmona. Part Ayes CFR Stab', o, A)n t. �. issued 1, ;he Sr of 4bor ,Oho.the^_opel.nd A,,. . amm,i, {y Sr al 9.S ed Ster I(tfl, 2 St., w, ; n,Stet li , Au tl 5 C _,ur.r a r. :.. abed below. Wlhhhnl,ii.aQ Taxal Medical Aid 6 Supplemental Pension (SS) ,2) That.ny Vu,roll.urhe,wiaee wile,thi.contras n9w.ed ro he .ubrartrd I.,the a W l e period ar.t eeeel aM the'Me wage me.for kiwerre or mech.nlca conned therein art m., le.. In.,the Ura Me PN't<' w.'dllrrmrm.ltm mcurpontted into MO r—ttu"; In.,gibe It...ifo..1ion. .er fo,th thererr.for eu'hel.bbute.,c nebuni,een� font with the work he Pellnrmad w Nh) Inoue nY .ppntntirw eamPleyAinathe aWw penal ant duh Petered m x bores Ode ague bcvs%gp peaeeum,eRute,ed :ppnnhce\niP ltencY Nntaed by .he Hareev rd APPntnllc<nhrp and Tr utub,, Umte41 Sbue DeP.Pment.of L h..or it ft even 1 Lribr,laM akency enetc m a State,are ntRlsn"i'd with the Rure.0 of Ay4nenHrteshw am TminmR.Un ted State.DepaMmmt o/LaM r (d) That: p) RHERE FRINGE BENEFITS ARE PAID TO APPROiriED PLANS. FVNDS,OR PROORARS ]( In.Mdum'0 the fer" hourly wwW rres P.Id to.arh latroret or ereoh.mo Ireled in the abr.ve,eb<renced par roll. P.Ymenlf of fringe beretht... Ironed In the r'gbtrart have tern nr will be made to appruph.le Program.In'the benefit a..eh emplaeee. [acept .e noted in SnOv.Olc)*flow (b) WHERE FRINGE BENEFITS ARE PAID IN CASH _.. Fa.h L.bnwr or mechanic Letts m the W r.refir oc ttd psY,nll has been{void s rndreated on the MYeoll, •1 Ie.,roan the a of the gPPlie\ble town"hoer"'wage rile Itm mr.0'he of the reQwnd bin Pe F<M`Ip u�r, „�..r•J r nvn,t, aYvnD!Vf nn1eA r]4 ettoh 1•A 1 below' EXCEPI'I1119 EXCEPTIONrCRAFTi EXPLANATION Arlene Whitwork11, Payroll Clerk Oa.B.No.11R-21%F ns 09.0m,L 19!1 Ep-pw °'i a°..� ,�.IP wS PLEASE READ ACCOMPANYING INSTRUCTIONS M.re••. •°ur4r•°N Nr I.-,P.L.L.Me,So—Ws. 101, ' ° °.ovou,[o r .v .ea toe.P.L.f . ?'rill.;,CF.C LOCAL PUBLIC WORKS PAYROLL REPORTING FORM BEFORE COMPLETING"NY PARTOP THIS FORI Pnf•et llmw /+.i.e'Ie:arim-Ietb.At I.,eerb.RAt* PLEASE WRITE MOWERS LIKE THIS: a,-1,at fit I lumv to I I I234567890 MLY INmiN IroleN Y, [yteyw'a IRS 11.. /q limit"E.•" PaPotl N•Nmi L.•t PayrNl POINT WIN WALL POINT PEN OR TYPE ' Ennr"L"it rh;a n vvu.Ls° s- Peerr Au ror x,,.pm('.vr_ PAGE t OF - PAGES v rx n le IS LEA LEA VE 6LANK -- --- c�P.I.mi•PPt Soaal t•cm:ty Occupa- Pay ACWt .arx"on Weab Occvpa P.y Aau•i CasmWeoupnt WeN. Nu/Oer uon Pun noun "It prepcl + _ pr.v. ^ ,a Spc�ai Security _ prev. e". Co. Won" I.,It" vnem- y�y Numl.r tion rwe hours n«praiser. PAY pen" "; plorep E t g coe< rose wer4" pay"'�oa E 'S pity" E a £ sWi 2 z ITI sw n " .• u " " A. ep . " 3 0 " w er sa ao Wt 1 ee .. / S M 1 21 3 22 8 21 - I N 25 II t Iz - u u 15 A a"a Oq rear Eyley"�tst"clove mi•eybr"M WATE rWEPANNa 2 i ?7 7F la•.+an Nay Sr:-State �onatruct ion. in RAIL TO: QiN,YWPEBNt iYNEe wl Swvim Oi•i.im N•Wa N Pinar Im"arial Row, (}yOwNaeler n EeNnnk DewI Athald"mom rlane ti`hitvot th str.N Aeon.. 7�9 2„S 5venug M.P.. U.S.DeprOeun N CNrree ❑YewNaetmi mennn"nr�Ntt city.stile,zip '.c3levner I%ashirtaro4 9$t)74 Room 8415.Win CaNara BNl. N bb mial" 1/1h St.ad Cmtlkb p Awew.K.N. TLL[pNpli' i-_)�'�•• I Tebpww No.a Cmbct Ana Co!•\ r:.. 'r Rtlhin NuwWr'-. e':a�. -. Ira,D.C.3230 u.-.of .cm.ea STATEMENT OF COMPLIANCE r la'm..We a..x loa, -February 15.�978 • • 1. Arlq'af whitNorth Fayr011 Clerk ap nr,rer uan: P e r —____.f rief -- At Thar 1 PeY or suponar The,pep,rn,of tM wr. n..ny,l q.d h ttoec c ,r. ,t the ill ta. ; ism Ju.'T'a the w.mll wow a,mmemtnY�n r�d.r of February A t: Iv78 mrd emrnyWDr ' .~,, Feb 197e. YII wr.�w emph"'t •n Tree Prolect M . Wit q.rrrd �1.'1. �c a"ehly aatay...'nact.the'oo raoste.M,r C.rn.e-,If be made.'char dfnclb w•.+r,-1y to or oo bow'of..ra Tri__ .QtB.te C071et1VCtion IRC Irom tbe full wehty ve{1 wreed. .ny pemon and That m>aeductruna here to� ay been asap either d'me11y or'MNectlr'�,o'M feu v.1N...rrcd by..y wrawl. other than"'TealWe de,wama...de LnM R.{xl.tiuna. Pan d(N CFR Sobrit!. A), 'asued by the {ecmury of Law'under the Copal.nd Aet.se emndW (y Su, 4e6 bd that 1 W,72 Sur thy:Tb St., JS1: 0 U S C I'bc). .ry Jew:nbW belaa: Withholding 6 PICA Taxes 801TCa1 aid & Supplemental Pension (fit) r.. That ea, Payrolta oh,,,,u..mdsr th,.c.nu.-1 rtVu1r.J to M wr!w.n,.t[nr lFe .b„t,a Pertod am r.m 4 and r nWletr, !heI the W.xe We.for ltrbnreao,mrCM1dntr.<MI.IrMd cite.".u,a'nor I... The.1". y'Vlrr••1dr y,.ep T.tei .'gLL.." To e aw deum,matf.A i..T or.lyd tat.If.confotut, d'al St."I...tfm.he.a eat forth d+.ro..ur each Iabowe.r r.eMntc ccr, Wm:af1h the.*M SeTIA h ld 3 (J) That.ny v,pwm¢e.t mph,vtJ tr he .Wee wn•.1 t—du11 mhutemd m e leme ba. Wvw.µ hap proenm ne'Heud a'th a Sum uW"o cwy),P .dwncy meaxnfseel by the Dur-.. of APPmmmewrp end Irnmmx, Uatted'mme DeP.nmeat ar L Wr,oe d oo.e.h TO.Whiod e{.ncy It at.m s Snm,.m m{t.lsr.d with tht,H....n.4 AePrrntmghy,.nd Tmort., V red (Hate.DaP.rhn.'of"W'. (H TMtf (u WHERE FRINGE BENEFITS ARE PAID TO APPNOIfED PLANS. FUNDS,oN PROCRAMS In dltrwn w the bast. hourly v..r me.Pau to"w h Irwrcr oe me:Mm• hued a,bs abowr mfemncrd wr roll. paynunm of 1nAe.bmTe4u u hu.d to the contract he" Men o, a'll be made To.Immpn.n p'Wr.na foe lbe by—W of exdf.mPloyua. .ae.Pt as meted'n SeeUoo a(e)bane (br WHERE FRiNCE MNEFITS ARE PAID IN CASH Each Labom'of mech.mc listed 'P the sorer re rrene.d p.rrnit h.. wan pat,.a morseled on the payroll. .n.mount eel be.then the sum of Hay.PPlmabin bests hourly wetly m mu 1.Plus the.mount rf the myutma Shoe. MMllle w hatai to'ba eoaMct..ae.pt.a..,ad to.eetwo d(c)belay, (c) EXCEPTIONS EXCSPTtON CRAFT) lyPIANATION I Arlene wh: mrth Payroll Clerk I...eo.0 o�nt c.. ..ou ... '_a r.e. oo1...v.1r YJ.OFf "�•• STATEMENT OF COMPLJANCE I. w.rYrr D•rvr �.1�{k fl.Thu 1 Par w N '.!�--- du nenq rMM: --�y��a��ypnru rM Drru.rm of INn Pr'nYwr mepinyM n r ' �1 Ins eu•M 1 r e a In•r aurwN ma p. I1 ._'"." ` u .Qe 4m Drnotl.w+memtn IaY a,d endvl_ Unr. y o�P}FFFF'�wYr[r� 1�F�e tl Yn Yu aY YI February.•awes ISiY. Y! {rfegna .ny1nY Jun uW �`.1 r.eyy WFra amw, wu m reWMe Mr,'bn Yr rlh ar Pmu<t h... b I, yud ✓ xaka" nwa a1Mr Mn[IIy w arYJncNr I•.Yr un Wnul DI saki MU--- ('.No°^ ..rn.r (eom tM IW I •n^AJY w{w wtad by.nn brrn m•dr.uner am'nr Y.nNeen llr Rom ve.e"n.,.a en.r w d.draDYM n.ry NaduMDOaa Pen 3 f 9 CFR Su I'N' tMY'WI wgela.art.ed IW ug Jwrwn >thar<Jru Perau+alr d,rS DJ SMt 1%, TI St., %?.ye St., - W b, M $fvrowry cl Gbo. .;ndn Me Cortland At.. rdu[QuoM..dehn.n 4�0 C S C I`ncr. n.:nv an n.nlrtJ Wl:w.r . . '.r.d•d rdF &.' �. Tha,an, n.1...11n I - tMr the w Ye ras•for 4G.re�W aevae[A r .r• - r, -IN- INN,drterwaut,on wear ado M c ewl uretl".N,It IDnn with lM wry M POnled rntrrr.t. IMI MY :INnYrf.�t uM Nr PI i n .Ir. .a 1 D4-.r Pnwraed I r h My rv•rn � r •en w4.nr or moa'MmD : 1• IdJ Tn.t a,r .wnnrreu rerobYM,e the abur •.n wart . S,AIv ePpan.ntu'eehap • •Penur uro du;; vNuwnd m. ♦.M Lb.a L Wr.n 1 nY A ncnSnwrd�y nttynwed by IW III n AJpnntt,W%,p ..W Ta.ra pPrfnllreshIF PV Fr fgi.nrtJ Slue.Depanmrnr DI Gwr. WAPY••u ale la a Stow. .n nauwred wnA'M Hweau of A F. Vnllea' 9ww[Drpalmml F•nnb[enbrP.ed Tn,nwd•Ve,wd Ib TheC .,. (u "ERE FRINGF.HXNLFITS ARF.PAID n'APPkOVED PLANS, FUN DS'Ub.UN UN PROGRAMS ;n aMuvn l:IM Wuc hruelY weFe rrtra p.ttl to e.cn MWnr ov w heed m rM.nOn abrtneed P.v ;j Dll. Prymenl I hang brnaDU u Lrud n rM .'DMnul have ww ar rUl W mrar r Im IN.WnerH 01[ueh omploywe, eaceP' ..mud M 9+olwn Mr!Mtw(b) RHERE FRINGE BENEFITS ARE PAID IN CASI/ '•PPmDnaa prlrp.nr. Finh L.Wree oe mearrma ❑e n amDum not wer IMn Poe ,n tla `W f re nlenecy N"IY paymV Au Wm W W Ya,uncJ nn a IM Wnrh,e..I,FMd in IM m eom Df M ePPt Mblr baarc wye nRe plus cne mount f 1Ae WYvll nwcf, eee[PI n Amed n un(sn d{Dt Wlur fe4 n fnnrw Iv) EXCEPTIGSS FFPLANAteON ------------------ Azlafe Nhltbrorih_LpeYrpll Clerk i aa•ra aN3q ve• :wc»ua Yeu ro.. .. a �—� a_ a a l., i 1 ' •' I0 LOCAL PU9LIC WORKS PAYROLL REPORTING FORM 123456 -78610 _ ■■■■■il�frili■, !la"I�mmH A 0 ■■%MON■oo�E■11�■■ ■ ■ ■■■■ N i's _Ron a © �■�. - -■ �'� ■ . ■n=aN■mn■� IS ■_��■ ■■ =s�i� ■■ ■n Nn�■emi1i1'�■m°■i i'■t'® ■■ i■i lion ennigoommosses loss oni1 0 �■■mmummoS■�N s ■ ■=■=sa■©■■■�■a ■■■■■s■■■n=sss sa■■■=■ GHmoss N■■■■■■■■ ! Ek■■n■■■m■■/!■■� H■■■■■ ■■ Ho ■ ' ■■■■■■■ �■■�!! ■■■■ �■ ■■ ■ , N■■■S m■■■■ ■■■■ ■� �■ � ■■■■■I ■■ ,,,, Ss s■■E s■ ■ ■ ■.■sEEm■Sss1� ■■E■=■s=1■Es!■ Ross r iiiiisI ■Es ��is son SO ■ ■nm■s■m■sommos■n■s■nnS■Em ■ ■■SENSE lrlasson sonME NONE i iiiiiiimii sipconsso on son EMIR = i Sol ■■Nam■IMMUNE ■EN■■samongsa■■■! ■ ■=s■■mEo■wommom=lamINNaEon■■■■N■ofoloommulangEa ■ �04 H � r �STATEMENT OF COMPLIANCE .=,0.Mau MV MRIb. 0 L 2".1 m ork l.,nrmnY vs.x. e in'Mhn I psY w.upervw tb yaywant o1 M..Wmws ewp:uYr^'-r 7erir lf�f� AnnwlwnR on me payroP L.noa.-ymran.,r.N,,.,. nlEla�ne }or ly, enq eadrnl M. y yl >�IEIVl7 In2. all PNeune aap1,91J art ."d pm le<, W. Wen W,d he lull s.Aly w.l..wn,e0, LWt m,raW'a.h.ve Onn.., .,o Its,m.qe a.N.1 Jrnrtly u,„sl neIly In yr.,.bah0lr al.„d Wi— !!! a IEbw*1 EMwrcN wawf Lou 1 - llwa age tut',w.'Ul..lea a.+.aa to NY wnm and that,w aMacuo...W va ee.n nude.itAb d,ra.11,uI asdbactlY Iron,Aw tuB w.p.enured by+nr Wee, uMe1 el,.n pelrr•en.Wn dedualws.ay datMM • Reluwlrvn•. Pan l (29 CP21 XabtHla A) ,00ua1 by Pus Srero,ary of 6ollne under Me C..pol.ed Act.as.nrMM (a5 fa., gal h1 Swt IW. 13 h,e• 9•iT:Tb Sw, !SJ• 40 t S c 1>6 .rW alee.nbea bone. t•itbbaUUwn Ai rich 2ham _ _ rlri t SA a a111d� ' .L Tout n..nai. u,r..ur anon.Mt.:.mtr rI rny.....J,..ew.uw- n.l I w Ina ds.ve Pr u.d.w Purm.a and.om i uw,Ib w.ur rcta.lu.Iabwa...,. wev-hanu-.'oeta,aet,inn,..,sea! t..A an. , n . JP,ble rwa:r rate .ueleu,.4 ,n .1,� »age Mtetwbu hun uRarysrg.d my Ihn vmwae,; '"' 'he rt..edx.naw Mt Xunh llneur fuI a.ch bWwr u,Hach.,,c b.w wetA!W wort b PIwn,N•d ,� ,i) TW,.n) .Wwnnt as annals,"fa ce.,tees.Pan..1.w duly et.,usPoo w.uu,,.fide aDywnnawah•y Pr•,Daw n'Xxwro.! .',Ih . W.le a9Prr ueeJnO aa. , Rcogeliaa`..y eht%,an .I Apprcnt,...piF .r,J Tl.nme Vntad Estate Depuos, n, Latest a,It ra,.ueh nc..gwuW,tale,e.mu en.Y.N., m.all P-d elth,he Bureau W ADDmnI.-•.hm.nd Tr....... Un,m, Sure,D.Wnmepa of Iwhyr a4) The,' (a) NIB'.RE VkMDE RENEE'STE ARE PAID T(a AVPW)VED PI..ANS. MONPS.ON PNOCJIANS Y. In•alrcwn m eW bHc Iwae:Y wsur rates pN.f b rKA IuWrcr ar mrrMNc ItslM ut the abvr rofernm'ed pN ,ull, peYwan,.of I-W Wn.h,u .s hslM m Ine suet—, have been ar well be .Is ve.pprvDnne Prolnm. Inr the bb/J of auen en,plOYu.. escpl o na,M In geeWa•NI I A.wr lb %HERE FRINGE BENEFITS ARE PAID IN CASH Hach Leltnn,o,wechml<' L.led n the eW...lens'""Yeall has ban bw s.vndmnM.n the I,.T n emoun,roI last then the sum of the opplec.ble Daam hourly wale nw plus the.moons ul the tequt b eemhu..hated:n Hascon,»d.ucap,....,ad P..dawn l(,)btyw. <,) RXC'EPTTOFS EXClpT1OM CEAaT) EXPUMATION 1 I �Arl�n� xAltwrtk, Winnou Clark , a o..P+_tq,e..., ..-...ea ,..n row:: •u,... ewe. v..a w...er ou<-....-. LOCAL PUBLIC WORKS PAYROLL REPORTING FORM 1234567890 MINE PAGE OF PAGEt--- 4 ® ` ea■gong onsono MN` s� w ■/sons■ ■ ==�i ■o■o■■ i=ss � ■ In=Olo Ig ■ ME Now sn o a M ■■on ■ mno ■ ■■■■ MEN on ■ monsoon ■!! m ■s NMEE■■ nNn ■■ ■ monsoon INssnns ■MMMEW 'i■i .4121■■0 MINEiiiiiiiiiiini■ ■I i iiiii� � eusiNn■su■Ms � _ �� ■� Fiiis soil on moresi i ii i■N'common won=M■Eii■ni■�i 1 iiiiiii Q■nn ■■ssn!■■ ■ ■ lEsm ■ M■o■■s■Ns■s■■■■■ ■ monsoon ME■■/E■s■■ ■■■ns■s ■s ■ ■=nns ■ sNN sMEN■ ■MIMs ■ no ■ ■, suns■■ IMES one ■■Ee ■ ■■N■ ■ . ■■M■N■i ■■..=.C.■�. .■■ on MEMO■I■■■ ■ ■■■■■■ on ■ ■�■�■■■■■/■�■■■■■■■■■ ■■/11■■ MINIMUM■■= ons■!■I ! _ ■ Is ■■o MEN n■N■■M■ ■ ■=i ■-.MEMN■N■ m■■sassN�■i■so■Io■■ni �■ ■ ■il =i■■o■NMIM■■■M■MEEI■�!=su ■ noun■■■ R.e[.no.wag oiaNON STATEMENT OF COMPLIANCE Nu lee•[iunau N:. N-RIOP} Feb, 1, 1978 _ • • 1. Arlene Whitworth PayrollClark dnn«n:byt<am� In.m.a 4Pa.nry 1.1w 1 I t That I pay m aupery ne l:ae parmant nl the prr,ona emptn:ul br Tri-St�W Construction. Inc. ,he Talbot Hill •hat d.ring the p.M11 I,,It 11.:,r,n.en.rns.r thr 21t)b, m Jan. vvnn torn ad."�I� e.aa 1471 and ehbh,;he�}jtG,of_. Fab. 14- .11 "... emplovrd on ..,d prniecr bay. been u.2d 11h, ieU ,Iekty wages earned that n,rebalva have been ar wdl be na le either directly III lish ecaly to ar on behalf oI xaid Tri_ $tat@ Construction. InC, from the full On.kI,wages«amen br any person and that no d.d.ouon.h.Te ic: ... Is..,nr... n.en made ruher a,mnh�rIt IMnec:h I— be,toll wages a mad b) , y I, it. .Ihi,in..pereesstble dedaclaon.as defined n Reaul.ti.... Pert 3 120 CFR Suet,(« A,, 1. u.d by the Secmtm 01 Lnwr under the Calmland Act. an. d memed 10 Stu US 63 Slat 100, 72 Star 961:'S AI.1 3it7. i S C 271't, and de.11nbed blow: Withholding 6 FICA Taxes Medical Aid 6 Supplemental Pension (�i) (2) That any "Trolly otherwaae under that r:n?act required to be .obmnted for the&have Perini,am comet and cvir.pLvtv, that the wean rat.'for laborers.,a ecbawc.c,ntuned them.. nut lo.than the ADphrable wa{e rote. canta,ned ut any .&W determan.a.mcoryanm4 rnm the rantrvL1. that the ctasuuuuonx del fultb them.for..Eh laborer nr mechame rote form with the wort h r periormed (3) That an, appa.nuces employed in the above Period am mIW regmmteJ in a bnha fide apprenuceahrD program ee[utexd alth a State appm t yAaap ap.., mcoAnaied by the Bureau of Appm-.¢«.rhq. and Teaming. United Some DePanmerat of L.bsn,or if nn such meappiaed Apeney costa m a Seam,an re.ibmnd wnh the Bureau of APp wm yh,end TrairriaaR,United State,Depam;.o'-f Latiar U Thai (a) W Rt NOE BENEFITS ARE PAID TO APPNOYED PLANS, FUNDS,OR PROGRAMS E_ in ueadian I.the ba.¢host,+name.'as paid'.each labor'., or h.." listed m the rib",retemnced p.p rnU. Da,menH of fringe bi n thta as lasted rn the cOuacl have been .• wAI b,•erode to appmprlam pmRmms for the benefit of.arh nmpl.yee,. ,.*P1 ..noted to Serti'rn 4111 behrw lb) $HERE FklvGE BENEFITS ARE PAID IN CASH Earth Laborer or a.eciwnic hared m the aW,mlemnced y.Ymli has be.o Pard as ward., red an the N11o11. Artwt not lee,IFan the.om of the.'P4e.ble bays h,.,I,+*sue m[e plus!he amopnt of herepuamd fr.Re bRm4tm a listed an the contract en'.R a*noted m tecuon ile)L..low !cV EXCEPTIONS EXCIPTION(CRAFT' EXPLANATION .a.., Arlene thitwrth, Payroll Clark [ Na 1 i qme '-t 11 L,I L 14111a'C III ON Or a . - CCSr.Y['[N re: '[CT rti[CO RACI*Ao 6bCO,,T C'O4 TO tt .ORC .n Yat. PRC.RC," ON y, E rEC.V, -=r Oe II LE 1♦IN.,B< SON te' O TEA I,OP S VN�T6Ot a'[6 F..V*M Iil . ....GiA.[TNI.aOtRa O.R[CTEY 1.TN[..n T.01 On C Wane. OY.B.ro aiR-EV6E ns I)leamear Sl 1914 i�c:�rinreM: +.r�`Ronlofe.•. PLEASE READ ACCOMPANYING INSTRUCTIONS BEFORE COMPLETING ANY PART OF THIS FOR .•t Io P L +,moo,T,n..,cx LOCAL PUBLIC WORKS PAYROLL REPORTING FORM Prala,l•a v: 'I,DIIa lXpiw:ICIry.n Tea.Cttny,Apal KEASE WRITE RnMRERS LIRE TNIS 1 23456 7890 ►REfT WITP BALL ROIRT PA OR TYPE .G LT Faa«p Prtfacr Ea. Eylo+«',IRS Ba. P V Para�EMN r IgnO NaafM Llal PAretl J I P....n o,r VR PAGE DI_—PAGES s pml.ar- t ra fa Ornlr.n•e LEA VE BLANK ' Gresa opal 9 Grua MaDnl Weexa _ Occuw Pto AC W,I ,rn ro Dn. a WaeYa ^ / Occun!' PRY Actal ,maa On p,er. r!F • !Dual Secwry p^et. $ Seetal security Iron late noun tnia p act unlm- y RunEer 'yen Puy noun au OrDHCI u •m- 'I6E Muepo cpDe coea +orktE fpr Inrf — •E pl:y.d t ,,do Coln Wv\eD ror mu .a plovaD 6 pry DlnoE Pry Nrroe • f' y .0 fl ft M tr fl ae tf b Y Y 51 6i IN at 6t tf {6 J ]! 1 I TT 1{ IJ 3 c u s 1a L 22 3 i 23 1 Qa • lE I LS xNMI - II 11 z 13 t t u 29 1— 7 u a Mena Oay Yw FAINO/aaa lVtaE aDew ara amofgol by r1r -.. 4r_4 Cott/L]'UCtiOEte :7 r/11L T0: pMl,MIMRaIMR n MAd M SlIfl ae 61visMR RATE PRE►AREB: r I J _ 1C1e.1 - FSwwiL DewlaEwal AMfeiMMla RWaaMIaaw PfMMEV RaRM: ItaaDpl« Strop ADDnY nRQ -IN F L, !3 ai_ _ U.S.D"WWAt of CAEIRncE a+ REEK 1415.NSA CeEEsfa BMa. �'.!'le W}litY-Jlth SwcaDMn Warrt'ria,t rrBrt Ciry.SyW.zIP ^l levtcad Tca®hlnaton gam. 11:r 51.M GNMUMiEP AwRw.N.V. RaMRoM,D.C.am M:iaa arlr 1 I Tpapnme Ro,.of Contact Aru CaN �.. TRLaWSNIEa: .. _ _ u•co.,.oc.••aa +. t STANEARD goer+ - =�' gnu,. ,..r I (Anr. 147t,) !c,• ,. :.r.ac:lbs ey Me wyt. ,,, 4u�, ,.r.. -- �.. ram, [... ,.. Bahia 1978 'n;a Itport If rt4uiro4 by Eat t•.c.•r i•• -..t!. F.l lttro Tq ttpott car, Nnttiona C;,n kc t,Q. Tot (Moos ad 1e0ottcn of Coai.tlo,sw #A"al rtua; (a.+. ..0 loostiun-of .eatnatar) Civil Rights Iilvisior. T1i-St..,. Cunstructiun, Inc. t:conomic Devalol,meut Auuiltt atratiun 959 - lo, rwugtw N.C- 1700 Westlake F.vunuk, 6t•l levuc, w.a hinyton 1J8004 Seattle, Washington 9e109 city of Ronton 6DA Project No z _ Pzo tt:ct aeription: Hill 1, y. ♦. f •. o. 'inc- total at.l Wft X..ra of Uo Avyo.ot (a.. rootnot.1 ritr ;,i .r u or of of C1aH1 A. a. rA er writ Eapby fit.- • kle- .jet ,.tan/ . 1 total toapYp4 W. (l.0.! Traea lien• Toto »rtoa 10 ,aau. k. ins ._ . l:aaol' too I. an0 1. Tri-State Constr- uction, Inc. Tr me l rs. 'Tr ruck :..��.� )r iv L raAt T C � Tr �� C C ,Oal spy C,'f It Pal'. °:entt�re u, . .. Dal °ta,a: al.photo NuOor (Inel.do !r" Cram) At lentt whitwcri h, A:.st . O•cL 1-30-78 _._� i,,>t)cl 455-257i,, Y71 Tri-State Construction, ALL. FEDERALLY INVOLVED CONTRACTS OP 1NE.Inc. IN AREA OF Penton KWET MI PUN FOR NON'n/ OF Jan. 1978 ? _F+y Southwest Washington 4'_T._R hTENT ACENCZ' CO G� liMR LOCATION SAMOONE L fq{pI.ETED PAVECCF:➢ COID'II:IION 6TZ Cevel:.paent E04/I.pw Talbot Hi II Puap 214,499.00 0 vctober, 1978 ,ia in strat ion 07-51-23908 Station ALL NON-FFULML MNMCTS (AWJL)ED 51,a5EyUEWr IO FDA-ASSISTLD (:UV"tACr) IN PLAN AREA FOR ABOVE MUST% "•u+f^uF F;RACT CONACT NUMBER IAICATION_ t Af'R1LNT T Cf4MPLF.TF.D PROAC,D COMPLETION DATE • CITY Of R6ATOh EUA-LPa Pkut:kAy !IINOAITY "'NESS EATdRPA15E UT1L12r ION AEPORT e 2 "TM/YEAR Jan, 1978 Project @ EDA/LPW 07— 1-23908 Title .._Talbot HiP pump Station Contract if-450 (CAG e ) Prism Contractor Tri-c ,en n nstruct ion t_ _ MlnIhAw Dollar Aeount Allocated _ (• _i of Contract) Mrnarity Lnterprnsc Sae 6 .Address Type of work Aaount Paid 0 10.S hu»oer This Month i None i I ' I i i I I� I 7 r III i I I I Subtotal Tnio Report S Aao"nt Paid - Prtur Reports j Coebined 'lotal Payaonts = t6 Pprcentaje of Cbnt r.Ct �— Prey"red 6s. ___ Arlene Whitworth _..,-__... . ..t r 1-30-78 Y-.RRPANTNENT OP LABOR „[a.P Nou.avl." STATEMENT OF COMPLIANCE FW.Appmes" RnMa yemc N..H.R109J Date—Dec. 7i lq�� 1. a le_ a Kh s rth _ Payronjl I Clerk Q)Thal I p-or We — 'IT'nereny'ute' 1 wnun,amPl.,tea of _ th ""Peruse the payment of e „11/Rol"rig en".a[I..<.. ,.ItJa,Id�!=� re� Dec. r Gunn[m<p,rrou cen.,n eommenoinR on rh< 9 na.Y of Dec. an' 1v,17.nd end;n,me�thd,Y"f Dec. Weekly w 19 77 .11 Psrwnx employed en a[ee e.ned, thu Iw rcb.te.have ha.,s"Will be made either dnectl said Proleq nave been aid the tali Mate cOnatruction, Inc v or TRIPI..Iv In ITT Tan behalf nl-aid Tri- u.m!vu�i�<r<. fmm the fml Weekly W,[..earned been,eACe either dire,ij,as,rW... . Y any P!es.and that no deamnnn.IT... n t 63 Stal I,, Pert ](29 CPR 5utbtltt, An.l na wetlrq�,ha Sxre hT of person, than pennialhb daducnnn.as AeOnM 9a9b1 Sat i%, ).5tat %l;76 Sat ,15);40 D 3.0 2S6c), and deacnWd he,nW,nder the G Withholding melanA Au. a..m<wea (15 sat n4 6 FICA Taxea _ Medical Aid 6 Supplemental Penaior1�) f2) That any....sll.mhenne sods"Thiaconntnct That the ra[e Tate.for la6oantrr stshnrJca nimdTeWNed I'he•obnined fo,u he.bo�e w.R IletelminNtlMl a<o theme Trot lees Chan N Ps".d a:c"mett and esmple.r fmm with the oh Is rporrtad Inw the contnc, That the M1a,ihcarion. T fond thin fo.�chblronr n+nnaM perfsnred n (3) That any.pprentiaa r meeh.nm<on- rnh a &W. .yprcnncs. s:0"y etn the above penal are dory m[ietemd m. was fiae Laver,n :m h eels [e"nY n,mueo a v:he Bom.0 .'A and TninN .reUmtean9tw.RrDam relutennimint,rea Sans Dep nment N IaW ued.Rm<v<vbn, SNIP.. ere m[nnmd WItM1 The Bursae of A m+mnn<.-<aniP,n:1'r„,N[. Un,,.a UI Thai:. (•) WHERE FRINGE BENEFITS ARE PAID TG APPNG4$D PLANS. FUNDS,O.:PROGRAMS In eddi ym to the bur nnurlY W.Re I',-Paitl to e.ch!.hoer or mecnanm O,ten m The•wve referenced pa Y. tI. a bsnenta of hn[s piny...a heed In,he c" act have Men.I w,il be made to a lo" he Irenefn sf.uch emPMyea,. steep! •e nnnd In Section.1(C)below (b) WHERE FRINGF,BENERTS ARE PAID IN eik �r"p",°t<prsRram, an IT La M�^or Is n than th' mien in the !hove referenced Pavro/i he. been Paid as IMicatod u .mnwt r leva than the,um"f:he aPph,,.bl,hair hsugY W.Re rate robe Ins amaum of me re henefita e[Bated in The n'ntn." .tarot nm.A In a<oIi"n.4",below n the Payroll. IcI ICUEPTIONS 9wmA loom EXCEPTION NICRAFT,____ --�- EEPI. ATION L Arlene Whitworth, payroll Clerk ' + e.1.a[ChON 8Y OHO. qa��OSOf.NRCON TwaC Par.NN•Ey 11/NI p T16. Ni TBC!`s . V RGua[T,•a"'as OiwRCTle 1.CY T••!We T.01 Op CIM[N T! O.M.S.No.41R 4%En u.s^ <wM 31 1979 v ED-)x pvi ie ov"E."..cOWRRte Two.„a«rb.,Hfm,, db le.,P.L.e.-I.a,a....101, ra,. etc.ur.,c M. u PLEASE READ ACQ311lPANt'lNG LkS7ROC710NS e ..I 105;P.L.9.�7,T,II.1,Ch.1. LOCAL PUELIC MORNS PAYROLL REPORTING FORM BEFORE 0DWPLEI'MG ANY PART OF 1797E FOR Nttaa Wpa: — Fre'N.Lacxlw:MR,orT.,Carh.NnM PLEASE VNI TIE*INSIDERS LIKE THIS: 1234567890 Y -Jig ONLY PWrx Project'ft.. Eaptever'e IRS N0. PN ParIM ZEAst PNrtlr R.7 Lax M1Yratl PRNIi WITH MLL POINT PEN OR TY►[ I� I IE ..L..N;;r .law for � PvyArr b. E p,EBLAN PACE OF PAGES it » )e rf.,+. LEAVE BLAMK "-'--- ----- G'�a°eQnrOo^I GrOaa amount Socral$ecw�ty U<tn4n PaY AcNral d on Weeks _ y Ocnh a. Pe A:u Weeks E Rumoer eon .Pen Deurs IDy vr01et1 OArev. w g& Semal SacurilY p Y t al earned on a cove 'Code Waned IOr INra a em. RumDer oon enod Danrs Inq Or07tU un _ s peY pano0 pvYjo Ed z ae coda wolked for Dora Zed t I pay panedW D B _ ►W a _ J N W M E1 k. 4 er t1 ee ee J 7T N N of !1 eq E1 1 Ek M z 17TTT T 22 a f-) 23 A 2 la I 25 • 20 11 12 - 1 F-I i 27 IS 4 { T< + _ u + — 2.0 1 Is 30 Marty OaY Y. Emprpye+,lie 0 Dove are empMYTa .y OA7t PtEPAREO: I(T"''-°^ Rems NAIL T0- qNl,InlMwtiRl 57rinW ilk 5ervilss EIYIa1M NaM o1 Per..pry aRl RNCA. coONKM Strcel 0.4aresa_____- EcErmPlc DMINptol AdaiRIDORIMI U.S.Depart"of CEIWwrtE - __ AStwrtrsgr MenoM1M at right City.State.ZIP_-__- --- — ROM Eb15.VbM CEMRENE EMI. Ana CedE PIZ-16 1 ' _ —_-- 14M St,A D.C. sU'N=tm A,~+N.W. IELEPNOME.�_Z Ghent. Txedidd.No.of CEntacl Aree Code _�OUTOR uxo.«.rc.uv.E r. ilk pamp sf o w oto ENDING F FIL FILE TITLE q `,1 n 74 L bof mp � b