HomeMy WebLinkAboutSWP2700294(5) BEGINNING
OF FILE
RU 'ffm EEG
MAIL TO.
INI11'NTRf.AI, labrIN' log, ' RECEIV AFFIDAVIT OF
Ileyanawwt of talon a 1ad.tre. WAGES PAID
arayy.�,gl-�AA��d,tkr�ll!m��.r{g.. &Awn NOV 2 S 198 ON PURuc WORLS CONTRA(-r
fgwl4dr�gtve:p kECEIV�^!�,?�,,ro•,��«,«"
DEC 2 n 1983 Contract Numher Con.N 061-83
JAN S liild _
(10 f'Mtc Bud Wea Due 9-20..83
of Renton 0.
Dale Contract Awarded 113+83
City t
Address 200 Mill Ava. N. .— Date Work Completed _
__ oanton W-_ 98056 Counts inWhich Worl Performed _...Kino
Location Wuhm ('o my Telephone Number a•I AA�rI
-- Was a Statement of la"m tiled? Yes L NoM
In compliance with RCW 39,12.04(1 1, the undersigned, being a duly outhorir-i representaPve of
KOHL EXCAVATING INC. 33iO h. Valley Road Renton, Wa. 98056
rcalrMn u-W\vir_rb�-_-� oAY�)
do hereby certify that the following rates of hourly wage and hourly fringe benefits have been paid to the labm,,s
workmen and mechanics employed by me upon the project described above and that no laborer, workman or
mechanic has ban paid less, than the "prevailing rat.,of wage"as determined by the Industrial Statistician Of the
Department of Labor and Industries.
List below each classificatim of la bur employod by you upon the Project described above and the rate of hourly pay
and hourly fringe benefits paid to each classiPcation.
Please Note
If apprentices have been employed on this project,provide this additional information.name,maistration number and
stage Of progression,
cma
Rer at V ae. low d Newly
H.-* Forr w Nylw seesaw Paid
OpaxrtK(undex i50H.P.) 1.7.43 a/.:l �a ft
PPiipolayer 15.16 A S.r/ 1
Truck Dxiver (16-20yde) 16.66 V .2q s't�
17.a., sty
., d(rr.
Opaoile�tox(over lOH.P.) �� 1A. ! o� deo%c
UI \. 17.11 xa: i.41i
N. Atr.0 Aaarrwwel snot... 4eeaea
KO EX NATIMG, INC.
Subscribed and sworn w fore me Irene., N.r.n '—
a/ By
this day of rna:u
VY /'� t• �� °Wa 'wA -,
a #. / M the on
wtY Mw Iystrswar Makf`.
T" la re r71y ai naawsM A 1lMl lnc lees as aM cur tow Sore W WuaryMr nwd�l
ItW I.IE11lAl. 41'A7ffi(1C7Aht
OF LAR11R AND INIR5
INSTRUCTIONS:
a' -- .ra Cur. _-JAN
1lA1-_.
I. Pursuant to RCW 39.12.040 copies of this farm must be Completed by the ::Iniracwr and each Of his sub.
contractors.
2. Complete this form in triplicate and have it notarised.
3. Submit all forms for approval tc: Employment Standards Division, Delvirtment of Labor and Industries,General
Adminietration Building, Olympia, Washington 985041
4, Mail an approved copy to the Contract .Awarding Public Agency
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUS_
CONTRACTORS.This is required by law and payments can not lawfully be made until such affidavits are filed,
�►r
satrlr aaM M\',A IMNI awda
RECEIVED MAIL TotAFFIDAVIT OF
.INDUSTRIAL STATLA'TWUN NOV 28 W3
Dw� w l.w � IaddaYMa WAGES PAID
6.alu�e.e Shaddrw DIrIWr daeeffluw AteiarMM ON PUB11C WORBS CONTRACT
f»c�i 7sT�gl�,r "�ECEIVED
JAN + 14 Contract Number _Con.f ObloU -
DEC E° 1983 Date Bid Was true
Contra ,,.,,
Ag' vtur w<...: Date Contract A.arded 10 SS V
ra
_dlb r� Date Work Completed -
Address ]OD Nd11 Asp ta_ County in Which Work Performed
Nre
kAWM". Location Within County
Telephone Number __-., ysI Rpn Was a Cutement of Intem Filed? Vs L' Nola
In complisom with RCW 39.1.1.040 I, the ucdemigncd, being a duly Authorized representative of
_ML gN&V4TL=A ITC. __39?0 D. Va1I a d Ramat_, tau•. gem
do hereby certify that the following rates of hourly wage and hourly fringe benefits have been pad to the laboren,
workmen and mechanics employed by me upon the project described above snd that no labour, workman or
mechanic has been pad less than the"prevailing rate of wage" as determined by the Industrial Statistician of the
Department of Labor and Industries.
List below each classification of IAMfr employed by you upon the project described above and the rate of hourly pay
and hourly fringe benefits pad to each classification.
Please Nate
If apprentices have been employed this project,provide this additional inkwmatioo.name,registration numbs and
stage of prgte ion
w
l rah a.ft fr Raft M Nf.tr
rtfelr NY - true,Fine" Nut
Operator(wder EOH.P.) 17,47 yof 3.SB
Laborer 13.16 3W 7�
Plpelayer 1s.M
Truck Orlwr (16-xyyds) 17.co—;2sy T.-4
operater(ovor loN,r,) 14.99
Oiler 17.11 yaf .3.0
Nd. A,u.n AdLuai 1Meu.. N,edrd
Subscribed and sworn to Imfore me By rent .y,g�/ V_,.
V •;w,
.1- _'�.'._ day of „ r�
4y 19 of-^S AN-p.W iy�fTawaJ or er►
A"**i Mary aN na I,, r W q nuf w Ma6 er.n tail,— raw
u the Pw•ad foo wens in as t1 non lest;Mk!w k.w.....flN
NoWMar w and far,A,St..d A. Nq,on..,,., INplD7RtAL STATIS71(.TAN fYudua
TMNT,T IAMM AND IFIOt CRIRASR
INSTRUCTIONS. JAN
as Duff
I Pursuant to RCW 39,12.040 vopics of thin form must be vvsmplcted by the contractor and each of his sub-
"Iraclors.
2. Complete this form in triplicate and have it notarized.
). Submit all forms(tar approval to:Employment Standards Division, Deportment of labor and Indmtrm,,General
Administration Building, Olympia, Washington 98VA
d. Mail an approved copy to the Contract Awarding Public Agem:y
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB-
CONTRACTORS.This is uyuired by law and payments tan not lawfully be made until such affidavits arc filed.
.qw..
'. ,t,,.eaaat .•....a surf ism or o
MAD VQ F;ECf.i�' INTZNT TO PAY
mums BIAL nrAr&nf lAN
D"Wom N eLabor
� a la"Mrsee r PILL' " ' 1Y .i PRXVAIUNG WAOZH
(PWi{a Worm Cwtraot)
tNrtyb.1k[tAMFt� Contrast Nunkrr
11N{1 711a-i�t�
J�� ANyt 5 104� � DEC 1 B M3 D.a Bid Was Dw___�.aaw.e.�.-_-CO~ AwmeptW�mevABmo! a.,.l.. Dan Contract Awarded tn-r"i-tt
Ansr.r, AP"
City of aentau Cawty in VIWA Work P+M6traai�-.Kleq.-•.-. .- .
Abner_ 200 MU I Aw. N. r Lo sum WNW Oamy—.. . —
Mntma wii 98036 Prima Cow,wro0!—.r..wt
!Male _.. :•oMm n's RgWvo w cleAl6aate No. gag)-III�K.".'t99yi _
Du You totaod To that Sabcontraetorsl Yin P Nr. f1&
In onseplisnce opL RI.W mp 12.OW 1, the ode siped &q a duly sutborised roptsantative ei
1cL LXCMJLLX�aa 33:1i 16_l�_Road �_ Nentonr Wa. 9W_
vtAr�`
do hereby car* that the following rates of hourly wage and hourly fringe benefits will be paid to all
labovers,warkman and mechanics employed by me upon the public works project dwr.bod above and that
no taborer,workmen or mechanic will be paid lea than the"prevailing rate of wage"as determoted by the
Industrial Statistician of the Department of Labor and Industries.
PLEASE NOTE: If apprentices are to be used they must be registered with the Stan Apprvnuteehip
Council or they most be paid pravedin g journeyman wages.
faArr SrIVAw�Oala'oU'a" NMIM.T !TT. raiaea rz;
Y -
Operator (under 60H.1'.) 2 17.43 ti Aafe1 3.6e !y.
Laborer 1 1S.16 its
Pipelayer 1 16.M �!/ -*.go -
]ruck Driver lb-2Oyds 1 1 .729 65
Operator(oval 60H.P.) 01
Oiler 1 17.13 y of 3.68
Not, Attack Additional BhesY in Nestled. _t,. XCAv INGO INC.
Subscribed end sworn to before me
met
N ear L a 1 Uw Odr
this day of
t9 �SY 1f APPROVRD
JI DepaM tot labor i tadartrl�a
yf'�y{��dfM�.1 ladut Blatbtleiaa
Nits, p,sar M w Ir the Sm.of weohv . Ny _ Dan JAN I
d
rw,inr u wathstsew,
BEFORE FINAL SET LRMENT can be trod•many VA&woks project.the Prime eerlMn*w and mah
and every subcontractor must submit form I3-700-7"AMANti t of WOW NN"10 peeiElert WM
the diaWrins eit of public funds F:ACH AFFIDAVIT OF WAM PAID MUST U C8RTff=BY
THE INDUSTRIAL. STATISTV'IAN OF THE MPARTMRNR OF LABOR AND INDUSTRIES
BEFORE IT IS SUBMITTED TO SAID OFFICER.
FROGRFSS PAYMENTS: Fach vou.her claim nuhmitted to an owner by a rontroctor for payment on ■
project estimate shall state that prevailing wages hove been paid in sm rdanoe with the prof od statement
or otatemmots of intent to pay p-+vailiag wages on fue with the public agenev.
COMPLETE AND MAIL #NTIRE SET FOR APPROVAL TO:
Empk jlM Ilapartotent of Labor and Industries.
Gomm,,: Olympia. Waaitittgton ti860t
00wTnM�TOM 9MTWUMM As POUR"
tenet r+nm gum t7WITRAC7--AWAKlral AGNIM
1 WAUZ A"-90"WoRY.agiYemttl7 M Mason"ee srparia, t
,,S
CONTRACTOR/SUBCONTRACTOR
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT L' Month: dane Year: Taal
To be ibtoitted to the City's Project Goals and TiebtaDles as coraitted
Lngineer during the let week of following in Contractor's Affirmative
nth while contract is in progress. Prime ,N Action Plan i
rontractrr is responsible for obtaininq and
s n all Subv ra to or per Clty's Men 9.1
To' (lire aM lacotim of Camille- Aperr Most i From: (Nr and lo,,mir of eantraetee)
Kohl Excavating, Inc,
City of Renlon (admitiia[or inq dept) 33X) E. Valley Road'
Renton, We. 98055
Is report is require y aecutive Order 11746, ect on 701. failure to report can
result in sanctions which include suspension, termination• cancellations or debarment of
contract.
3. A. ►.
Wino. total 'total
Kohl Excaval ing, In . Douro of kmpl.yaont (See footnotel rit number umber
lit0 E. Valley Road y of of
Claaai a• • v/n of mtnorit •mpk•y.
Norrt on, Wa. gEO55 Rio- er. Ao tan/ ,oral total
Trade fita- Tot• Rla ck nd lan Patine .e- Employ eu
Conpany'a Kamm If.C.1 tloro panto Ar) c
Truckdriver Ti'u, f
rive Tr
tiperatcr Group 11 DPAVNNt-
tor
Groin 11 r
q,
AD
t4wrator, Group 111 Tt
Vlnmlxmr
71
A
Tr
Ti I
AD
Tr
It
T
eapany - cio s n uro an - e ;ale 31aneU e e ono Fua or
(tnoludo Area code)
Delores T. Kohl • president - - t `o
Rev. 11i'77 (*males c Females, ••Minorities ► Non-minorittes) Page cif
1/80 (Submittal Requirsoments c city's Goal e/Titrtabla s) ---
CONTRACTOR/SUBCONTRACTOR
REPORTING PERIOD
MONTMLY MANPOWER UTILIZATION REPORT ♦ ' Month: Ma Year: 1ot33
To be submitted to the City's Project �� Goals and Timetables as committed
[ngimer during the tat week of following �' In Cnntractor's Affirmative
nth while contract is in progress. Prime N Action Plan
Contractor 1s responsible for obtaining and
anilsmitung all ox plaports. or per City's Plan 9.1
To: lease ad lsratlas of cowia ce grey pop ) From: Isarsea IMRtea at M.I.)
City of Renton (administering dept.) Kuhl Excavating, Inc,
3330 E, Valley Road
Renton WaaM tun 4130 5
This report is required y xecut % r er i rot on . , a ure to report can
result in sanctions which include suspension, terminntion, cancellations or debarment of
contract. _
f
mina. total total
KOM EXCAVArINC, IN work Hours of I.mploym.nt 19eo f..twt.) rity nuebor lure"
3330 E. Valle Road e/h of of of
y AA.ai •• mInorkt amPky,
Renton, Wash, 98055 'tab floe- Tota nLrk kla- ndi an tartme so. total maple., wee
Compatty`■ Nast (Lr.) Ilona papplc elk'l ,ale
Truck Driver Trk
..E Oriec r
l)(1C CAtOi, Group 11
r
Operator, Group Ill
t'
Operator, Group TV AD
plumber AD
T
Working Form.,
Pipelayer AD
Tr
Pipelayer An
Tr
Ap
Tr
��C k Betas 1/A14�F' 'inolueo area cod.)
Delores T. Kohl President June 1 1981 20t-251_ t
Rev. 11/77 (•MaIH a females. "-Minorities 6 Non-minorities) Pe Re of
7/60 (Submittal Imguirstants a City'a ;wls/Timetables• --
INThEl UND WE Eunic 1DlK M Mt 11TILILATLON REPORT CCITT or RENTONN)
The Employment Otiltaatton Report to to be completed by each subject contractor
(both prima and subcontractors) and signed by a responsible official of the
company. The reports ere to be filed on the day required, each month, during
the ten of the contract, and they shall include the total work-hours worked on
the project for each employee level in each designated trade for the entire reporting
period. The prime contractor shall submit a report for its work force and shall
collect and submit reports for each subcontractor's work force to the Compliance
Agency that Is funding their construction project.
Reporting Period . . . . . . . . . . . Self-explanatory
Compliance Agency . . . . . . . . . . City of Renton (administering department)
Contractor . . . . . . . . . . . . . . Any contractor who ham a qualifying
construction contract with the City of
Renton.
1. Companv's Name . . . . . . . . . . Any contractor or acbcontractor who has a
qualifying contract.
2. Trade . . . . . . . . . . . . . . Only those crafts covered under applicable
EEO bid conditions.
1. Work-hours of Empl ...,lit . . . . . The total number of hours worked by all
employees in each classification; the total
number of hours worked by each *minority
group in each classification and the total
work-hours for all women.
Classification . . . . . . . . . . The level of accomplishment or statue of
the works- in the trade. (C - Craftwrker -
Qualified, Ap - Apprentice, Tr - Trainee).
6. Percent of minority work-
hours of total work-hours . . . The percentage of total minority work-hours
worked of all work-hours worked. (The cum
of columns b, c, d and c divided by column R.)
S. Total Number of Minority
Employees . . . . . . . . . . . . Number of minority employees working in
contractor's aggregate work force during
reporting period.
6. Total Number of Employees . • • • Number of all employees working, in contractor's
aggregate work force during reporting period.
+ Minority is defined as includi-ii Blacks, Hispanics, American Indiana and Asian
and Pacific Islander* - both men and women.
Of RFti
� A
„� a THE CITY OF RENTON
MJN,CIPAL BUILDING 210 DILL AVI BO. RINrON.MA6K.BBOei
j( BARBARA Y. SHINPOCH. MAYOR • MAXME CWTOR.
CITV CLINK a (206) 216-2604
rro sBP�e�
GUIDE SHEET
Name of Department _ ��, �S1I e i ` @4 N\- `.
Title of Record _
Real No. 71
Date of Records
Beginning Fila
e> 7-9'3 U .
Ending Filar in
Data of Records
Date Ni crofilmed lT 62 DncumBnt C"n
Camera _ / - _RHO I ReductiaL Ratio_ 253 x
Operator CL. Sti\ e..+YLA
Remarks
Film Inspected By _ Date
Inspection Results
t '
OF R,t
WtTHE CITY OF RENTON
MEINICI►AL aUIL01Nd EEE MILL AVESOaENTON,wAEN 9aEabF BARBARA Y. SIIINi GCH. MAYOR M MA%INL E.M070R.
gyp" CITY CLERK • (:UF} .'35-:500
CITY OF RENTON )
COUNTY OF KING )
STATE OF WASHINGTON }
I, - , being duly
sworn on oath epose an sayl
That the documents and papers appearing on this
roll of film were done in normal course of a working day
and documents are true and correct copies of the originals.
That the microfilming of the papers and docvments as Afore-
said was done pursuance of, and it, conformance with provisions
of the statutes in these cases made provided for as they
appear in RCW 40.10.010 of the .revised Code of Washington.
IQ�ht� p, �-r.,.as.�
S gne
Subscribed and sworn to before me this 114d day of
1, it gc .
Notary Pub is r,n en��or the
State of Washington, residing
in King County, Washington.
1
END Of
ROLL