HomeMy WebLinkAboutWTR2700715(5) W-715 WEST HILL PUMP STATION WTR-lO
#7 Payro1I Sheets
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FILE TITLEE
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M. D. MOORE CO..140 LFuvA ®[T 4m/ni I1 r firma
13652 SE 107th PI.
P.O. Box 2603
RENTOK WASHINGTON 98M ,o.
Pages 2654076
TO A 87 ,il- _O --
�o- ._eAw, .
_ WE ARE SENDING YOU 4�rt_tached Under separate over via the following items:
❑ Shop drawings =: Prints G Rana ❑ SerrlpNt ❑ Specifications
❑ Copy of letter Change ordx ._
CpN[f, _DATE Mp. DFILIr?i1pN
Y4y
THESE ARE TRANSMITTED as checked below.
❑ For a roval C Approved as submitted ❑ Rnubmft_copies for approval
or your use C Approved as noted 0 Submit_cowes for distribution
❑ As requested C Returned for corrections ❑ Retum_ corrected prints
C For review and comment ❑ ---
❑ FOR RIDS DUE _. _I9____ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO_ _-_..__-- —
SIGNED:-`~�d'+n
Imau`fe'a w r rr ew.rs..m en mr..,w.a amwv .xn-..w
PAYROLL
U.S. nEPANTM(Al Pr uaoR e�qw Burru ne a-RMmI
wWc AND HOUR OWISION
(FOF CaotrectoF's optional Use; Sea instruction, Fonn Wlost.) —
wuE or fan1RACYM: Q•fMIN01RMCYea MIEYfa '
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IMMMIOLL -
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KAMC MFREse.AND Lya� g _ laTAl M/e AMICKOVIOaOY KNOW
conAL ascuenY RUusu a cwrneATMaM - 1 MMOMM! a FAY E I MED Nu RaMaMMe A. SF' mw! erinrt om
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FORM ww-arr 0,.1 - FORMERLY SOL I,—PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
U.S. pEYMTNENT OF U PAYROLLBOA euesw eu�u Na KR1Jil
wLGE AND HOUR DIVIEMN
(For Contractor's OpHonai Ux; See Instruction, Form WInst.)
1NNc cr,r!omA TOPL I OR[UeCONT."O" Lf ♦OORE�
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DIDUCTIOMY NET
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SOCIAL SECURITY NUYB[R `� ClA34I1U11aR O' '.. } IIDII� «� EAMYO [Y MOWMD 8[rl.11
OF EMKOYEE Y i O I HODRe woM®e my TAX
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FEWER wll-[[[14E0) - FORMERLY SOL 1e[-7URCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
1— ADPro�A
u.s. DEPARTMENT OF uOOR - PAYROLL
WAGE Alp HOUR DIVISION
(For Contractor's Optional Uss:Sea instruction. roan WH-347 Inst.)
pR NRIOOM NR ADDRESS
NAME or RsnpnpmR LI
T PAVROLL �<n — I0-11 aal aMO1Xp p wr__�- ' / CT,wOln 11e� It oAv AND DA N IIr
cEDuC r:'
rNws
NAME MDRE6 AND TOTAL
O N O lEci ow fANiiuiCil eMaOf.
ErNnAEO
`OTAL aCDPXUMIFR HOURS Or MY HOLDING O\Eaa •dY4 ram\V � ( l
01 EMPLOY HOURS
Wplplm EACH OAY I TIDE
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U.S. OEVARTMENT OF twaOR PAYROLL fornilp'""�6
BuaIH e„na. Nn as-alx�
.AGE AND Ncum DIVISION (For Contractor's Optional Use;Sea Instruction, Form WN 947 Inst.)
YE d CONl11KTW ON EUlMM11M'1.OR IIDDPE8]
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OEPAMMEXT OF LABOR PAYROLL ;,;,E.1":°' `X...-RID+
WAGE MD HOUR D:YIMON
(For Contractor's Optional Usa;See Instruction, Fomi WH-3/7 IDEL
rAEEAE Of CDIRMCiM f� M BIAOGffMDADB AOOYM
FAVIN FM MEEK MIGMO
(41 O11Y AMID GAVE t• IQ DBDUCTNM m MET
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NAME ADORESS.AND WORK O l.. / 1M 1• �MMY A m� A`//� OrXOI =M 1 PRroOe
SOCIAL eECUPrtv NUMBER ` II FNA 11GDIND •r•UEIIO M' fOR WEEK
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OF EMPLOYEE g i• O HOURS WORKED MOM MY TAX
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CONTRACTOR/SUBCO 0 ACTOR '(
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT � Gil Month;"yr ka i Year:
To be submitted to the City's Project ^ Goals and Timetables as committed
Cngineer during the 1st week of following F in Contractor's Affirmative
nth while Contract is in progress. Pr. NT Action Plan t
Contractor is responsible for obtaining and
submittingall Subcontractor Re rt or per City's Plan 9.1 1
To: (mass ae• lw Atim at Cequeec• 1'aese•y Is"t.) From: (sr ata locatM•(sestractw)
OIC10K LtE<SRIt. Qa1
This report is required by Executive Order 11246, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. 2. ). h. Z 5. 6.
JIs -' eino- Total total
work Hours of amployssnt (See footnote) rrty number ter
of of
C lase) a• ryle- er• Isien/ ,041 wm of minarl Emyiy-
tlet- • total Employ- eae
Company'a Name (I.D.1 'nd• Lion• Tot• Black panic ndlan war,Pacif '&I wT *as
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(include area Cod•)
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Rw. 11/77 (aNalmm i nmalmat eaNLnorlties c Non-mdnositimQ Page �_ of
Cltv's r;oals/Timetablesl
ur arunan.alen� PAYROLL
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CONTRACTOR/SUBCOOIICTOR `r( r1�, •
REPORTING PERIOD
110NTXLY MANPOWER UTILIZATION REPORT �' Month:,', Year:
♦ •
To be submitted to the City's pro]ect Goals and Timetables as committed
Engineer during the 1st week, of following 6 in Contractor's Affirmative
nth while contract is in progress. Prime Action Plan ►
Contractor is responsible for obtaining and or per City's Plan 9.1
submitting all Subcontractor Raports.
To: (mems saw loch is at tlltance ANer 09" ) From: (mess, mad lecatla et semereeta I
bua9- J� •rn Sub
l.v nn..+oe�i+]A. g1tC Zen
This report is required by Executive Order 11246, Section 203. F ailure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1, 2• 1 e.
3.
1 f Total total
rit
work Hours of Employment (See tooCno[e) rity ^'seer umber
of of
claaei •• • H . • • w/n of minority Eapby-
N
c a- er. LLnJ .oau1<t total
'e Fa< ( D.1 ac ndl
E,ploy- Fee
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a wuxter
(Include area Code)
Rev. 11/17 (*males c Females, eaMinorlties i Won-minorities) Page J_ of
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U�yy�rrtr� PAYROLL
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CONTRACTOR/SUBCONTRACTOR `'C Y fj�l REPORTING PERIOD
MONTHLY MANPOWER UTIL17ATION REPORT �'� Month: lJti6✓�� Year:c9ly
To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of following �f�, in Contractor's .4ffirmative
nth while contract is in progress. Prime �� Action Plan a
Contractor is responsible for obtaininq and
submittingall subcontractor Rew rts. or per City's Plan 9.1 s
1 0: (lye and lecetiea of raglleaie Ay y DWP j From: (aaae end loratiea of ca[racterl
City of Renton M. D. Moore Co. , Inc.
Engineering Department P. O. Box 2603
Renton WA 98056
This r dirt is required 1,y Executive Order 11246, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment e'
contract.
1. 2.
m Sna- total rotal
Park Mcnre of Employment (Zee footnotel rity nO0ber uct r
of of
Claeal e. a • • w/h of minorit Empby-
flce- . Ria- .e r. Asian/ total total FmVloy- eea
company-a Name (I.C.) 'rade tione Tota -lack panic ndien Pee Yle ?a, w t, eea
Sa ift _ate
c o a
N. D. Moore Co. , Inc A
911035833 carp Tr
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7. Cc-pang 'a aLrnature an e . 7a.r _tgneA c. Telephone Number
.� (Ineluae area Code(
Montee President
Monte D. Moore', President Au u t 1 4
Rev. 11/17 (-Males 6 Females, --Minorities 6 Non-minorities) Page of /
7/80 (Submittal Requirements B City's Goals/Timetables) —
/ Date: August 29, 1984
Project West Hill Pump Station CM Mo. 045-84
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
Of Augi,t � In accordance with the Intents to pay
Prevailing g Wage filed with the Washington State Department of
Labor a Industries.
n. MoprP n- Tnr
Co., Name
By a,
Title President
a M. 1 52 U 1 CO.,IV LO:M0 T F 17O�1ti1G1Sa& O'�T L
13652 SE 107th P.
P.0.Boa 26C3
RENTON,WASHNGTON 98056
I Ua
Phone 255.6076 •^wr G G
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WE ARE SENDING YOU a," Q Under sepanne cover via � ft following Kama;
Shop dnrmgs r. Prints 2 Plans C- 511mpks ❑ ;pacificatms
Copy of letter Change order
canna avers wo. ce neon
- 02
19,
THESE ARE TRANSMITTED as checked below:
❑ Few approval CI Approved as submmad _ Resubmd--copies for approval
or your use J App..ved as noted Submit_cop,es for distribution
O As requested Ci Returned for corrw,ons .., Retum_oorno ed prints
❑ For review am comment ❑
❑ FOR RIDS DUE 19.. . _.. PRINTS RETURNED AFTER LOAN TO US
_---
DOPY
SIGNED.
isrs+aaw .agar.wn n aaewWrae era rAr r e•IaL aula enua e•M
US GUAKTA11M1 u1 e uon AfFv _;y PAYROLL Apo.wK
rep •u,r«, Hn ..-•lon
W.L MD MOUII omMOM
(for Contractor's ODUonal Use; See instruction, Form W 7 Inst.)
H..Mr or comftl ct011 on•Y•i oPrn01CTM ADOAW
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or[rnoru •3 i p Roue srM•Im nwv oM' Visit
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US DEPARTMENT OR LABOR PAYROLL s%NRRN ro.w R
BRsnR rr r w.RIOM
WwE AND HOUR omt10R
(For contractor's optional Use;$ee Instruction, Form WH-317 Inst.)
NAYE OR COMTRACIOII M B,,CONTRACTOR ❑ AooRca
AND
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U.S DEPARTMENT OF IAIMR PAYROLL
6ugrt Ru.r� Ma µR1093
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(For Contrallor's Optional lase; See Instruction, Form WH-347 Inst.)
NAM[OF OONTRRCFDII OR WAMOMMECE°Il ADDRLaO
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us DEPARTMENT DE "Sort PAYROLL
b4M Bu,ru Ma M-AIJ91
W.DE AND NDUN ONINON
(For Ccntractor's OVdunai Use;See instruction, Form WH--347 Inst.)
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OIAI ICURITT NUMBER J pG D VAI°LAINII NeRN
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us DEF"TMaT OF tABOn PAYROLL W4at W,xu Mn Y-PID3l
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(For Contrattot's Optional Use;Sea Instruction, Form W14J47 Hutt
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_\ M.D. MOORE CO., NO L(Eu- A ®IF�Q�/A�J��G'�ICIP4G1d
13652 SE 107th PI.
P.0.Box 2603
RENTON.WASHINGTON 9SC56 a a
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Phono255-6076
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WE ARE SENDING YOU Under separate cover via_ _the following Hems
Shop drawings Pnnt+ Plans Sampan LI Sfsacificarims
Copy of letter C; C)mnge order _
coots Dart to. _ otsCrnnrorr _�
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THESE ARE TRANSMITTED ae chocked balm.
❑ For a rorat ❑ Approval as submitted 11 Rpubmit__copies for approval
or your use ❑ Approved as imted ❑ Submd__rapies for distribution
9 ❑ As nouail ❑ Rot,Fred for corrections ❑ Retum_corrected prints
0 For renew and comment C
❑ FOR BIDS DUE _ 39 Cl PRINTS RETURNED AFTER LOAN TO US
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u.5. DEPARTMENT OF LABOR PAYROLL x.rsa ao..+�.Na fn-nlool
WAGE AND HOUR DIV19(GN
(for Contractor's Optional Use;See Instruction,Form WH-3471nst.)
NfME Of CUN tPAC tUN I I ON $l1UCUNI NPi-iUP 41WNEes
ARROW STEEL, INL. 229L5 HWv i WOODINVILLE, WA 980%2
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U.S. DEPARTMENT OF LABOR PAYROLL
WAGE AND HOUR DIVISION 9,.1sN aR.x��N..++-RIIWs
(fa Contractor's Optional Use;See tnstrucUon,Form WH-347 Inst.)
NAME O( CUNTRKlOR N sunc,,",PACTOrr 1 +W>O Iss
ARROW STEEL, INC. 22925 HWY 9 SE, WOODINVILLE, WA 98072
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WAGE AND HOUR OIVISIlRI
(For CatlraF'ter's Oplwnal Its+;See instruction,Eonn WN-3I71nstJ
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M. D. MOORE CO.,IN• LIE T90 (IF 4RUS909?T&L
13652 SE 107th PI.
P.0.Box 2603
RENTON.WASHINGTON 98056 e•r —T„e,q
Phone 255-6076
TO _
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WE ARE SENDING VW I�ttocw .: Under separaN corer va.. __the folbwin{ iNms:
Shop drawmgi .7 Prints Plans O Sempin U SpeeiScations
Copy of letter - Change order
Cpa,O aaR NO OLabrlRrpN
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THESE ARE TRANSMITTED as checked boos,
For approvalO Approved as &. mitted ❑ Resident_ ___.copies for approval
yl!'for your use Approved as noted ❑ Submit--copies rot distribution
-- As rertuested - Raurned for coneclrons l7 Return___....corrected prints
C For raii and comment __- __.__._ . . _._.__.__......._._.—..__.. . __
[. FOR BIDS DUE— 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY M -- SIGNED:�G[QGF"
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M.
1. SE 107th PI.
P.0.Box 2603
RENTON,WASHINGTON 98056
Phone 255-6076 •«<•
T
TO C i�
WE ARE SENDING YOU X-Xitached ^ Under separate cover vi, Ne following items:
❑ Shop drawings Prints ❑ plane ❑ semplae 0 Specifications
❑ Copy o! letter '.: Chimp order ❑
Cpflra MTE I Ne. O[eCr1NTIW
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THESE ARE TRANSMtRED as cteelyd below.
0 Far approval ❑ Approved as submitted ❑ Resubmit _.copies for approval
for Ine r use ❑ Approved as noted ❑ Submit---coves for distribution
❑ As naluested ❑ Returned for corrections ❑ Return.__._.corrected prints
❑ pee review eel colo nt ❑ -.._
❑ FOR BIDS DOE 19 _0 PRINTS RETURNED AFTER LOAN TO US
REMARKS---
COPY TO ( / --
SIGNED:
+r+w_iFW r r,,. tl rtlrrwr ae M n wepl.uWry nwxv.r•r
O.S. DEPARTMENT OF LABOR
PAYROLL e.a.�eo eau rvu .1_R IM3
WAGE AND YOUR DIVISION (For Cent,&CWS Optional Use;Seelnsirudion,FDrm WH-347lnst.)
PnuRE se �.._
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WAGE AND HOUR DIVISION (for Contractor's Optional Use;SN IRStpEction,Form WH-3471nst.)
ADDRESS
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LONTRACTOR/SUBCONT TOR `�Y r�
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' �' month;<<., ,,5, :s Year:
To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of following -I in Contractor's Affirmative
nth while contract is it progress. Prime Action Plan
contractor is responsible for obtaining and
submitten all Subcontractor Re rts. or per City's Plan 9.1 R
To: (w eM Iecatlm of LAMItenca Ae mor Dept From: (name ad location,of s °armor)
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This report is require y Ezecut Ave Order 1124h, ecllon 03 ka,lure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
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7. Comparyl iclal'a signature and Mie B. bate Sigma 9. Telephone Nun,ber
(ieelude area Code)
Hev. 11,'77 (-Males 6 Females, '•M,rcritres 6 Non-minor.tlen) Page of /
7/80 (.'.ubmittal 6 City's finals/Timetables) --
E_ _
CONTRACTOR/SUBCO CTOR `�Y rj
REPORTING PERIOD
MONTHLY MANPOWER L"ILIZATION REPORT Month; Year:
To be submitted to the Citl's Project Goals and Timetables as committed
Engineer during the 1st week of follovinq in Contractor's Affirmative
nth while contract is in progress. Prime ` Action Plan %
Contractor is responsible for obtaining ,nd or per Cit s Plan 9.1 t
SUbmitCln A!' Subcontractor Re rts. — P Y
To: (Wm Yea 3--tt a of CAVIlaaca Aawcr 981M I Fram: (Its• age taemisw of eestraetot)
CENTR9L PMNTI\G . 1\(
4749 A. Marginal liar l.R,
Seattle. %A, 981 1i6
This report is required by Section 201. ratio" to report can
result in sanctions which include suspension, termination, cancellations or debarmert of
contract.
1. �• 7.
sit o. Total total
York Ncurs or Employment (see footnote) ritr number nimbor
of of
C Les( a. e ' ' ' vT of etnorl Employ.
• BSc- er. Asian/ 43 total em to eeo
CcapW^a 6ua (t.D.) T�� Lions -o!s Black panic •ndlar. '.'a r.ti'1t Fig vIn ems Y-
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(Include Area Code'
Rev. 11/77 (a Hales a Females, --minorities i Non-minorities) Page of
7/80 (submittal Requirements a City's Goals/Timetables)
us OEPARTMERI Or ueoR PAYROLL s.unwr Ra M-WI•
WA L AHD HOUR DrviMM (Fw Conlraclw's Optwnil Use:See Instruction.Form sill-3117 InsL)
HA,.E Dr co,.*�RAnCT011 ❑ oR a.roRreRero.
•A.ROLL 110. TYDR DER ERex,• -s-y
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socau s.cu•nr HUM.0 g cLAMINF oAsrOM 1 "DO"" w nw rINRI•o m. HOLwrw :51D N0 onla .F•ecT,s.1 roR•Rnc
OF rA1PLDnc gig 5 Hour woo=dFAr ow rMl
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Fo.r F/,4H1 (,.'60) rORM(RLY Ml Ill PURCHASE THIS FORM DIRECTLY FROM THE SW OF COQMIMR
V s UIY.M,MENf OF IAIEIM PAYOLL MG/�Ba/.e Nn..NUIYI
/rKh WU/MWY Mn51011
bier CeMTaelers OiYroeel Usr.See ILMAeden,Fe{Ew WN. &q MK) �{�
..NE Of CONTMCLON 01L.18CDFrf11C Td .L RUA j/9 /� ). ARGi,� k/'� e �6
L IN PPatCT wE Ca Tw T ND
i.TROCL ND fpi WFLM ENDING P901ECL Al.\UC.TION
7 htiL unK S o,V
— nl ly Ll� N 41 DAY WD wTE .SI lei Ili le/ 19�
� oEt»xnoNs Nn
N.VAE.AMPL59.AND TOTA, RATE Ww6
Sp LSECUPIT NUMBER ap• f.L.141WlC�TION
O C ].� 1 HdliK Cr P.Y .MgII.T fK. I�/E.. /.•. OTN{{ TeMI 40
\X IMPLOYCE S�� [APNfD D�N4 /l F� FOP WFEN
T O EIgIPS WORNFD 6E<:X WV
zsF3 i7p" ,x S.c. m .+ ,/ (AfS.9L -o- /•OS /•38bL
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EUFM WN}ll UNM EOfMEMt SOl H.-PUAOMAS6 THIS FOAM PINE-TLY in"I'll 1 I-r W Om E el ST,
u S. DEPARTMENT of IAooR PAYROLL
WAGE AND HOUR DmSKM (Fa Cudr eWSoptio"ithe;Smhntnb tion,Fo WH-3471nst.)
NA"r nr rnrvERns mR oR wxcDNiRACroR ADaIEu
1,. .c_G,P� �A. ARROW STEEL, INC. 22925 HWY 9 >E, WOODINVILIE, WA 9BO72
voR wEE«ExDl«c Q_ b,.9 • MIJECE AN-, icc
rA wDii xo. fi f 4' •I�H f' SlH' _Ai
IU YDg (3) 1 lO WY AND 1411 I51 (A (91 f91
M rT iW In IF S IS aDSE _. .- Dr uucrDws __ _ wNIT
AGl.E
N.E.ADDRESS. A"o 111dRA b I 1 TmY 1(AtL AMOIIMT wliw
socuE r Emn v l: R 13s�g I aAyMncAno" IG 11�iZ )3�t4 15, I Nouns a nwv EAArm I — "WEDDED 14 onrEx
Wv EMHOYEE i /_ I ..n,os "MIKE.
"nuns won«ED Ea- DAY
R0 WAbtAOFJ TAOFH I IG '71
ws� I/37; 12481 �g 19
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raw WM 7 Ores)—rcRUEALr SDE i.--PURCHASE THIS FORM DIRECEEf FROM THE SUPF. OF DOCUMENTS
U.S. DEPARTMENT Or LABOR PAYROLL
WAGE AND HOUR DIVISION (For Contractor's Optional USG;See Instruction,Form WH-3471nst.)
NAM[ Oi f.ON1NnC.,IN 1 °N SONC(1NTRAl;ION A(">NE53
ARROW STEEL, INC. 22925 HWY 9 SE, WOOOIN9ILLE, wi 98072
EON WIFE EIll PRJJER AND IOCAl10N E�,t�� l M
RAr3°I n ;. h 5 V n.I. 4fl Cr_6'f$- e'1
Ill kTg I O) N UP IN" (L lc O) DEWOTIONS _-- -. ... MILE
MAN AOD AND r 1 T N rn F '�T TOTAL MTE OROM: NON l
soCIAL SEGMm Nw nis i cussWlF°ICATION i I I Z 13 �_. / '1 NO11R9 of Mr EARNED 1 ra r.nr: I%i4L ..,L ( On NEE �K N
of EEIMUMEE gig `fl,i eemelNNrf fw wEEA
I,D, N, ,WORKED FAVI OAI TAX
I � I
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FORM El DI00—To3NEEN.r SOL M—PURCHASE THIS FORM DIRECTLY FROM THE SUM OF DOGUNIEMTS
CONTRACTOR/SUBCONTRACTOR Y
f�, REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Month; T. Year:F 14-
To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of following r�e, in Contractor's Affirmative
nth while contract is in progress. Prime Action Plan %
Contractor is responsible for obtaining and
submitting all Subcontractor Pe or per City's Plan 9.1 Reports- — P
To: (0100 ad Ietata® Of Ot+atamee Agamq OW From: lamr�Apm 1 eal
C/rr' OF 10-e.vj
EneGiti Ee.Li.vG 0 P EDAM
07th
13 0 E. 107M PI.
RENTON.WA e90E6
This report is require y Execcc ve er 11 41. Section M FaiTure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. 2. S. k. % 5.
6.
mino- Total total
Work Hcurs of Employment (See footnote; rity number taste,
or of
Claaai •• ,• � T or mlrortt Employ
f 1<a- His- war. Asian/ oral total
eompary�'a Name (I,C.) :rode tlona Tota Blaek panic Indian heIltt e_ w/n Bailor- as
IaLnd .ale
A4 b A4 4nee_ -, Ju AD I
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.// �c/�, (tn olude Area Coda)
r iE �` fj_/LQC�L.�/' �rG/7,'�k A5 '. (r•✓"cCi�{. ?z{: 2S -4�C� 7(�
ke.c. II - (•Ntales 6 Females, •'Minorities 6 Non-minorities) Page of
,/BO (Submittal Requirements S City's Goals/Timetables) -- --
CONTRACTOR/SUBCONT TOR `Q Y fj
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' �' Month: Year:
To be submitted to the Ci.ty's Project Goals and Timetables as couitted
Engineer during the lot week of following J in Contractor's Affirmative
nth while contract is in progress. Prime ,'�� Action Plan L
Contractor is responsible for obtaining and or per CitY's Plan 9.1
sub=ttln . Subcontractor pe rts.
To: (men W lecatlr of reWllemce Aommcy aep Fria: tare W Iret/r of rmerectee)
MD MOORE
PO BOX 2603
RENTON NA 98055
This reF>rt is required y Executive Order t12d6, ection 203. allure to repo" can
result In sanctions which include suspension, termination, cancellations or debament of
contract,
t. z• 1. A. y 5. e.
aim. Total rotal
York Hturs of Employment (See footwte) ritY number Iumber
v/h or no `D y-
l'loeel e• e• e e minority Em b
e Hle- er. telen/ ,oUl to[aIa
7 nde floe- Tote Bieck ndlen (acute 7e• Employ" <u
Co:pagy�e same lt.C.l done panic telonI .ale v T eee
C
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(Inelvee tree code)
>acre[�r'y 9-2S--.d "206
+e.. 11,,77 (*Males c Females, --minorities G Non-m.1ncrities) Page of
7,80 (Submittal Requirements g City's Wals/Timetables]
Date:
"atct NEST A116t RWP fx No. QV-5--A
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of .- .?' in accordance with the Intents to Pay
P revai ng Wage pled with the Washington State Department of
Labor a Industries.
M G? M E e—e� SnAI
Caaparty Nas ...,r
Title _-rec�yYtFA5 .
M.D.MDDRE CO..INC.
P.0 Box 2603
13652-S.f 107tn H.
IttNMW,WA 9e066
13652 SE 107th PI.
P.0.Box 2603
RENTON,WASHINGTON 98056 pp e•n/'/ Q
Phone 251.-6076 •^•«, - �t -
TO , d'
WE ARE SENDING YOU P Attached :-- Under separate cover via the following items:
C Shop drawmlls Pants C Plans C Samples ❑ Specifiatwm
❑ Copy of letter Change order C
odn6 pan Nq. oeacarmon
''4 f-' ;r ,
/ 2
THESE ARE TRANSMITTED as checked below.
For approval ❑ Approved as submitted Resubmit--copies for approval
For your use ❑ Approved as noted Submit—copies for distribution
As requested C Returned for corrections r Return—_corrected prints
For review and comment C__^
'. FOR BIOS DUE. 19__O PRINTS RETURNED AFTER LOAN TO US
REMARKS —.—
COPY TO_._—__.
SIGNED:
netel*« «.ray ue 0 w».
.•CONTRACTOR/SUBCONT 0R ` '11 0� REPORTING t6RI0D n,/
MONTHLY MANPOWER UTILIZATION REPORT �' Month: 6 z� ,, Year: d 7
To be submitted to the City's Project �. �� Coals and Timetables as committed
Engineer during the 1st week of following !�. J in Contractor's Affirmative
nth while contract is in progress. Prime �'� Action Plan t
Contractor is responsible for obtaining and or per City's Plan 9.1
submitting all Subcontractor Re rt .
To: (Mown mad Ixatim of olMIllaaee Ae. " I From: (mom eta location of 1
(1E`I "•l r'.1lNT t I`
C/GS `i,. ,;ar0�mal W&y S.W.
- �i'l^ WA 98106
Is report is require y Executive r er 1 245, action report can
result in sanctions which include suspension, termination, cancellations or debatoent of
contract.
z. a.
1' 7. Z Total •t&I
alto.
Mork Nauru of Employment (See footnote) rity m of Der
T or of
Ci1es1 >• a x of minor! aepby.
a His- mown. Asian/ oral to[al rm ems
ComPany'a Name (I.D.) I, Clone Total Black name Indian faetM a Fe- x(n eeel�
Ly. de Island >le
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7. CcePa ny Cffl cla!'e .ignatu re m . e Da[e 3laned o. Telephone Lumber
(Inolude Area Cede)
Rev. ;l/77 (-Males 6 Females, `-Minorities G Non-minorities) Page i of /
.•nts 6 City's Goals/Timetables)
IS OHK:MFMTMIAIOR PAVIIOLL . aa.xiura
NAce.No«Due omwN
(FM Cg1laealaJ1 O(1Mawd Uaa:ba InE1ruEKon,form W N- 747 Insl.)
NAUEOr EWTRRITDR Lj Sl;e TR.KTOR f � � 7;s
PwROLL NO rq1 wEEN END. fROIECT.0 LOCATION PIIQIECT OR<ONTR4T NO.
2� 13l % .Ar MA ANLI DATE .1, 4"
la•
a DEDOCllmo, NE'T
MWE AWR[H.AND 6 T LC' TOTAL I. Daor� wiTN' WAGfS
$OLNL SCCURIIY NOMB[11 tl�� CLASSIWfI(JTIDN D / 1 �l IY 5 1�I 17 NWRS Of 11Y a1AWM OTNU Tnr4 IAID
fM.M rK.L «WITS D IU LJr}�LK, rOR l.
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CONTRACTOR/SUBCONTRACTOR Q Y r
REPORTING PERIOD
nONTNLY MANPOWER UTILIZATION REPORT �•' Month�(pvt:.uLF,e Year:
To be stWmi tted to the City a Project ,^ Goals and Timetables as committed
Engineer during the 1st week of followinq �'� l' in Contractor's Affirmative
nth while contract is in progress. Prime 'ti� Action Plan •
Contractor is responsible for obtaining and
a in all Subcontractor Re or per City's Plan 9.1 t
To: faem and location of Itee3 O� e WAY aqt. iron: (amm re Iwttw of a mtw)
f.—/V Df le.cn: 6. Vp o,c F" c's, r. c,
ego% M.L4 40-- .S.. -n. ,JxX:;o cca
wc,a ra.J . A, 9to5V- �,t,v.J 'WOO. 98056
is report is required by 6 Section 0 . Failure to report can
result in sanctions which include suspension, termination, cancellations nr debarment of
contract.
3. mtmo- etal atotal
Pc E � Jj/yr<, York Noun of t.aployaant (See footnote) rttr number fer
of�p.4 Ayac4V��5➢ C.enel a. .• Hie• er� :e tan/ 043 tptalf ainarl employ-
`'—� _rode fica- Tota Black ndiac Far 81e re- hploy' Bee
Compeay'a aaN (r.D.) done pane ielmd ale a? Bea
Q VAl�t C, e.a t c ' to / _ _ _ _ _ _ _.� _ ,Z
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Itnoluae sees code)
Rev. 11/17 (*Males a Females, **Minorities s Non-minorities) Page of L
7/N.t (Submittal Requirimeras g Ci.y's U,als/Timetables)
US DEFARTMEHT Or LABOR PAYROLL F.. A*P-.
WAGE .AND HOUR DIVISION Bu4M Bumu Bo-LLNIU]]
(For Contractor's Optional Use; See Instruction•Form WH-347 bw*
MAwr corrt RAcrom C eR wincommemirrm ADDRrm
PAVIIOLL IID. MOR '�/ ..._' fDr MID SDGI]DR r— —CONEMC]N0.
o M1984 _
eD ONE ROD DAti IR M m ® nA
wWE ADOR[9tl AMD GROSS pm1ICTDRe 12T
FOWL SECURITY Re1NY S C]ABDIIW110M wom �• HOURS p MV ANOINT MI)14 1]i. pile WAGES
or EMIIO]TA f S IlouRo]]oloom oICH ear uRR[n r1oA IIDlelrlD .4 �l en10 Eaemre Eo]vmEER
S 1- e- o _
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----- - — -- -- — -
i
rDIIM/N.Mp 11/m_roteRWlr BDL ]a4-PURCHASE THIS FORM DIRECTS] FROM THi SUPr. OF DOCUMENTS
'U.S DEPARTMENT Of LABOR PAYROLL TO""A0O1O"6
Nu4•t W,ru N t4R.09)
WAGE AND MOOR DIVI•IDM
(Tor Contractor's Optional Use;See InEVuction, Fomr WH-347 Ind.)
NRM W CDNTRACTC\ OR MM'i 1M•ROR ADDRESS
A,/ re iar. K R.2�'rSc ,_ �. -- f=r lkyT. 4J1. 45a6Y-50im
vm• ND.—� ADIND _�FLEAIO '.'`T- rtr MDf
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9f S O9011CT1011• NR
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:gC1Al•ECURnv NUY•G g 4aTIDM MOIIRS Of MY I AUNT 1111N lti Cllr�` 1•IR �•
OF EMRIOYaE O No1R wommfACNORY URN[O TmA NTTLMWM ,,& eF✓ � ° m,,nm Ni raesl
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CONTRACTOR/SUBCONTRACTOR Y r
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT C' ��' Month: 10 Year: �-
To be submitted to the City's Project Goals and Timetables as coamitted
Enqineer during the 1st week of following N � in Contractor's Affirmative
nth while contract is in progress. Prime Action Plan $
Contractor is responsible for obtaining and or per City's Plan 9.1 R
submittingall Subcontractor Re rts.
To: (New and location of(^Ilan- ywq OW From: (Nam and letotiom of aameratter)
City of Renton M, D. Moore Co. , Inc.
Public Works Department P. O. Box 2603
Renton, WA 98056
This report is required by Executive Order 112i6, Section 103. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
2. }. A. f 5. b.
min.- Total .otal
Work Ncura of EmploYrent (See fo,cn.te) rity number iurber
o[ of
Cl::sl a• e. • • • WT °f minor It don pby.
f tca- • Fri
s- 1mer. ;Stan/ ,otal total gmpi oy- eee
Company's name (L C,) "cede tionn Tota Bieck pa,,i, ndtan Feeifle Fe- W R, eee
Iola" .air
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7. cos qy rl • re .>ifnature an e 8. rate Signed q Telep^one Number
(Include Area Code)
Chris F�Pro3. Mqr. 10-74-84 206-255-6076
Rev. 11/77 (•MdleS 6 Females, *-Minorities 6 Non-minorities) Page / of
7/80 (Submittal Requirements 6 City's Goals/Timetables)
• •
CONTRACTOR/SUBCONTRACTOR `�Y
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT L' �� Month: IC Year:
To be submitted to the city's Project j Goals and Timetables as committed
Engineer during the 1st week of following `1, in Contractor's Affirmative
sainth while contract is in progress. Prime N'C Action Plan
Contractor is responsible for obtaining and
or per City's Plan 9.1
submi ttinq all Subcontractor Re rC s.
To: (Y aM lecat Ion of LAllance &4 a y D.P.l From: (Name and leeatlm of ematrectee)
City of Renton M. D. Moore Co. , Inc.
Public Works Department P. O. Box 2603
Renton WA 98056
This report is required b,, Executive Order 11246, Section 205. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1 e. 3. —' 4, f e.
min.- Totalrot*!
work Hours of Fmployrent (See footnote) rity number umt<r
w/rl Of OT Lf
Claeal • c ' ' ' nlnorlti F.. r
(1 ca- Hie- er. ae lam/ .a tal total
Co nputY'a bane (Le.) Tnde hone 'ota Hlack paulc ndlan Parlftt F< uT r sl oY" a<e
Iew,na .all
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- *,-� (!.clod.<ArH Coda)
Chris F ik Froj. Mgr. 10-24-84 206-255-6076
Rev. I1/77 (eMhles 6 Females, —Minorities a Non-minorities) page / of
Reouirevents i Cit 's Coals/rimetabl s) —
Date: October 24, 1984
Project West Hill Pump Station LAG No. 045-84
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of_ p} r in accordance with the Intents to Pay
P revall ing age IIad with the Washington State Department of
Labor i Industries.
M. D. Moore Co. , Inc.
taapany Name
c
Title Sec/Tress.
f
CONTRACTOR/SUBCON CTOR REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Month: `, ,,,1.. Year:
7b be submitted to the Ci ty's Project Goals and Timetables as committed
Engineer during the 1st week of fol loving in Contractor's Affi rma tive
nth while contract is in progress. Prime �� Action Plan i
Contractor is responsible for obtaining and
submittin all Subcontractor Re r or per City's Plan 9.1 f,
To (saaa and lacatla of Campliamcm Aaamcy amps 1 From: (mar mad lecwlm mf tastractee)
JId oR t,E,7r,q- Cu
lY•'+r'Wcc�lal. QSO�V
This report is required by Executive OTder 11246, ection 203. allure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. 1. 3. ,../ k. f 5. o.
f�' mino- TeLa1 Cal
Work Hcura of Employment (See rootn:tl) rity nuaber water
wA or of of
b�C4Of f,.�yC�lC.l.l_ CLea1 a• Hit- er� la tan/ Dial a1r Empty
tick- a total Fmploy^ its
Company's Hum (I.D.1 Trade Clone Total Black panic Indian A^!^.e Pe- win eee
is a 1 ale
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company official'* Slan& Qr* &yA IL114 V. pate Sibnea 5 Te epnolm Musser
(Inolude Area Cade)
Fo_aoi,tau f C
• 1, 117 (*malas a rormtea ceMinorttips C Non-minorities)
X D. MOORE CO.,IN* 0.1770 VF 4MMOTTURL1
13652 SE 107th PI.
P.O.Box 2503
RENTON,WASHINGTON 98056
Phone 2554076
J'
TO
- C:iG Gys -,
WE ARE SENDING YOU _-'Attached Under separate cover na_ tne followmg items:
Shop drawings r_ RrvMs Plans " Samples _ Specficatlons
Copy of letter - Change order
T'
COPIES y CAIC MC __ CfaCal.lpn
WL , .
THESE ARE TRANSMITTED as checked below.
For approval Approved as submitted Resubmit copies for approval
For your use Approved as noted Submd__coli for distribution
As reciuested Returned for corrections _ Ratum___corrac ed Dnnis
For rev,eir aad comment
FOR BIDS DUE._ 19__C PRINTS RETURNED AFTER LOAN TO US
COPY
SIGNED:
vnw E1efr.erne w Ar rvv
M. D. MOORE CO.,IN* L(Eme cu irmhmmoumiL
13652 SE 107th Pl.
P.0.Box 2603
RENTON,WASHINGTO14 98056 Q
Phone 255-6076 f
TO i
WE ARE SENDING YOU f,"Attached Under separate cover via.the tWbwing Kerns-
Shop drasvngs Pnnts Plans ❑ SOWO*S ❑ Sped9cetlone
Copy of letter Change order
Coll" wrc tw. o(ScenraN
THESE ARE TRANSMITTED as checked below.
For approval Approved as subm,tted ❑ RMubmR__Copies for approval
Far your use Approved as noted ❑ Submit__copres for distribution
As requesten Raturned for corrections ❑ Return-_corrected prints
For revww and comment
FOR BIDS DUE _19__C PRINTS RETURNED AFTER LOAN TO US
REMARK$_.__—.
COPY TO_._ __
SIGNED,
CONTRACTOR/SUBCONTRACTOR cm -
4REPORTING PERIOD
MONTNLY MANPOYER UTILIZATION REPORT Month: (j�f�L�i_' Year:To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of followingin Contractor's Affir ative
stonth while contract is in progress. PriTv Action PlanContractor is responsible for obtaining
submitting all Subcontractor Reports, or per City's Plan 9.1 i
To: (nose tat/ location of raglltnct Aeoncy DW i From: (art and locotla of costrectw)
M d R MECHANICAL CO INC
668 N.E Norinlake V:a';
Seattle, WA 98105
This report is required by Executive Or er 112ab, ction 2fZG6)FOgj;ir�lap report can
result in sanctions which include suspension, teltni ation, cancellations or debarment of
:untract.
1. }. a. a 5. b.
mino- Total ottl
work Hours of Employment (See footnote) rity number umber
k/h of of of
C lanai t• c. • ' minorlt Empby.
t Hie- er. Peian/ .otal total rat to eee
Company's Nara (LD.) Trada Lion. T... Black park Indian tan P.efRe Pole wR� ees Y-
Is e 9
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7• Coey.ryoft,ftpalls 314. ntte 5:gnea 9. Telephone lumber
(Include Area Coax)
33 2 73i
Rev. 11/71 (tNalea i resales, **Minorities S Non-minorities) Page L of
7/80 (Submittal Requirements a Cir,•'= Goals/Timetables)
PAY Iu.m AApwN
e WR.1 w...�,Nn w-RIrn3
WAGE AND HOUR DIVISION
(For Conlractads Optio[wl Use;See Instruction.Form WN-3M7 tnstJ
NAME OI COFUFU`CTO�/.... OR SUBCONITUU-TON AIapR[55
,4 /� �7e�litJN`7CA � VV Zi6,5
S /`4� T OM:.GN R.CI NO
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NAME. ACORESE. AND N� l Ir 1��'//'fl � TOTAL RATE GR085 C�
SOCIAL MCUITUY NUMBER Si# CLASSIFICATION `,/�rS Iy!/ /.Iul I1LGi UOUXIA OF ... AMOUNT
WIFTH fILA NOLf NGV/�,/// �i Milt IpIN PAIn
DI EMPLOYEE U Nu11N5 WORN[O UCH Onr I lAy r �`. 14
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FORM wN-su °rno--LoRMLRLT wL lea-PURCHASE THIS FORM DIRECTLY FROM THE SUPI. OF DOCUMENTS
us. F unOR PAYR L
WAGE AND HOUR DIVISION
(For Contractor s Optional Use;See Instruction,corm WH-347 Inst.)
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U.S. DEPARTMENT OF LABOR PAYROLL
WAGE AND HOUR DIVISION
(For Contractor s Optional Use;See Instruction,Form WN-3471nslJ
NAME Of COXiNAtiON I ON SUtlCOXINM;iOS
feA Mr.MLF MUIN,: r c. PRO I /J/ '••. j/N ``// ; �+Y]�- Yl:llll
PAYROLL Nfl. I / N T/J
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I59 N J / { // ! J IOIM RATTE .FOS> WA(iL5
XAML ADPREV. AND QQ- pONN 6 `MOUNr WITH q iIIIM PAMI
:DCUL $L f.11R11y NUMBER $p;. GUSSrtIC,AiION W / Z_ !,j HOURS OF
A• nrNfO FICA 'NUIDING ] 'IHIH dd/fn9N5 I'M Mr.
Of IMPLIIYI! . 9 MI IIN, w r.Fl.l IR1:11 DPY ��/�-._.,
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A 104110 WX 7 k""T -FONMUIL♦ SOL Ibf—PURCHASE THIS FORM DIRECTLY FROM THE SUPT, OF DOCUMENTS
M. D. MOON CO., 1 11 U
13652 SE 107th PI
REMON,WASHS'1GTO4 98056
a��ar��raa
TO
WE ARE SENDING yOU
Attacfild Untler —_--
separate
SOPP Arawm �nrer na_
p - — - -the /W —
r_ _. Pnnts Ip,pr,l nema:
Copy of leap ❑ Plan,
Change order Samplas - SDecifi
co"" V-- — 4tlGna
--- " e, 7w
THESE ARE TRA �----� `�—"NMAir"ED as chWJM halow.
For approval
ur you, pae t-'
rfd'l - aufimitteo
_ l' Reartprtyt
As eeprryryp ..r APpsrsva0 as pGIM ---.-.<op'es for approval
U Subm t
L: Foe ryvNY!arq coolowsnt U cprrechon. F) RMum --coores to' oistntwtion
G' OR RIDS DUE `"--'—.--_-.._.-. _ —"omractae pants
REMARKS_„_ PRINTS RFTURRE'D --.
— —_. AFTER LOAN To US
kN
COPY
-- e SIONED: <
,awe,aw+7 easy..
CONTRACTOR/SUBCONTRACTOR `(y �10
1 REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT c' Month: Yeai: �
Tu be subautced to the City,s Prolecc �r ` Goals and Timetables as committed
Engineer during the 1st reek of following A y in Contractor's Afflrmative
nth chile contract is in progress. Prime Action Plan
Contractor is responsible for ubtaininq aN or per City's Plan 9.1 _!mittin all Subcontractor Ra, rta.
To: /Ymr aM lacatla .e 08"Ileac. Agame, Opt I F rom: (nam, wed l.c.tia. er conaracter)
This report is required by Executive Order 11206, Sectinn 2U3. I-allure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
•.
'Inc- Total ratal
Work Hours of Employment (Ee. fm:tn..te) rlty number tuber
Of of
Cluel a. c. a :. . r/h of ainarit)Employ.
Hie- 'mer. ""n/ coin total
company Heat fI.D.) Trrayde tier:- Total Black par 'n01en 1 �a a rrh 1.5lOY- ee.
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-lubautte: is q..reeents 6 City's Goals,T imetatlr
CONTRACTOR/SUBCONT TOR Q.�
REPORTING PERIODMONTHLY
MANPOWER UTIL12ATIOR REPORT Month: Year:To be submitted to the City's Project Coals and Timetables as committed
Engineer during the 1st week of following in Contractor's Affirmative
nth while contract is in progress. PriAction Plan k
Contractor is tesponsible for obtaining r per City's Plan 9.1submittin .r'.: Subcontrdcter Re rts.To: (Aaam and locattoe of Cagllanta Af—Y 9-" 1 From: (nave and loest 1. of eantrastee)
This report is required by Executive Order 11246, Section 263. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
2. 3. a. f 5. b.
wino- Total atal
York Mourn of Employment (See footn.te) Pity number umber
vT of of of
C lave'_ a. .a c. c ... . minorts gmPicy-
Hla- er. Asian/ .otal total Fm to ees
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Mev. 11/77 (*Hales a Females, **Minorities L Non-minorities) Page _L of
'1/80 (Submittal Requirements a City's Goals/Timetables)
PAYROLL
U.S. DEPARTMENT OF LABOR
WAGE AND HOUR DIVISION (For Contractor's optional USe;See IastruCUon,Form WH-3471nat.)
NnNE Or CONrRAC R ED. 'If)) OR SUSCON.RwCTO nLURE55p
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N
PAYROLL m
V.S. DEPARTMENT OF LASDR n,..A«I n,.. N ae.Rrrol
WAGE AND HOUR D"ON
(Fa CentFRctm"s Opiionsl Usk See MslNrelioD,Form WH-347 Inst.
1"t OF CONJRACTOR OR WI QWRACTOR ADDRESS ,
M � /v/ 17ANCo� .Q. �Yif/c- . �lc�'✓y� /)LC /(/c...�//i �1 �� lt.'t/ -�H �//yr L� `% 5/c1J
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NAME. AwRE51. AND 3 I .A•DRS HJ (_' jyf TOTAL MTE AMODNJ N�r•I
SOCIAL. SCCDROY MIINRER GIA591gGT10N �G+�/`1p 'Vq.L0Z1 17 ��! OI PRY r A N)IOq c'( u�H[N IOTN PAID
(F CURIOYEE EAi1MLD I 'UEDUCIIDMS f(rR WEfN
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U.S. L/EN AARTT OF LAWNPAYROLL e_aloXa
WADE AND HOUR DIYHiOM (Fa CpDIgCLaT'a ppliMu)Uae;Sae lnpructfon,Form WH-3471ns1.)
ApMtES l _
All
fly/!p�✓ va rli N co11t �/ i
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PAY11OtI N0. /�1.`ZI Y- �� ///�LL 11�•�� • � IVI
CI ` eI DAY ANO DATE �/ iE INDUCT
i0 [FI�� ` rv0
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NAME. AODRLIM NtD NDNF y�}y s }} pp�� t� 4 IOCAL a/,1! upUryl WITH .J� 1()LN PI1M
]OI;UI S[WIIIT!'NUNMR ali IIABNCICAi1DN * ,_L,{Y La�'W ZI 7•P Zl NOURE Ot PAv f>HN[D :ICA NDCOIry4 (1�. OiNCX 9fWp10NS' TVN WY[F
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CONTRACTOR/SUBCO . CTOR c Y REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT " Month: rr, - Year: ;
To be submitted to the City's Project ,' Goals and Timetables as committed
Engineer during the 1st meek of follotdrlg r l in Contractor's AM dative
nth while contract is in progress. Prime 'v� Action Plan
Contractor is respons'*le for obtaining and or per City's Plan 4.1 \
submittin al! subcontractor Reports. —
To: (mssa u Ixatim of r^liancs ysaer pays i Frov, (nowt and leeatiea a/ eotrestwl
✓�c�eR ft[.�Rt.
This report is required .y Executive Order 11246, Sectiont 203, failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. �• y. '•. y s. m.
.Sno. Total otel
York Ncurs of Employment (See fOct'Aei rity nuaber usber
-A of of of
Cla u1 a• e. • • mimrit Eepby-
flca- Nla- er. :niani .cttal total FnD1oY' ees
Company 9 Nase Ilona Tctai bLck /t....c r.;1 Lr. 'y1e ie- tea
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T. company cffiplal's Sane on en a 8. Date Slaneo 5. Telepbwv A.eb<r
(lneludo Ares C0601
0— ., ,, leyrles 6 s•«,,.,t as.`•eMitarities s Non-minorities) 11— 1111111 of �
M.D.MOORE Co.r% d� � VF OTMAKSu OMIL
13652 SE 107th Po.
P.0.Bo:2603
RENTON,WASHNGTON 9SO56
Phom 255,6076 "" i ? -s-y✓ -1'-Xy
xvA) Dt`.�o�u
TO _
I`_ itG.4G 5 - c
Lzz&,,, wa•
WE ARE SENDING YOU C''AttrtnW '_; UrMer separate cove. ,a _the following items:
Shop drawinµ Prints plans C SampNs .J SpeUAcetipns
Copy of letter Change order
cwras MR ro. nwur
aA-YY 1440oz 4.e
7/7
n
THESE ARE TRANSMITTED as cbecved below.
For approval Approved as subrnmed ❑ ReteMlyt_.._copies for approval
43—f r yocr use Approved as noted 0 S~O copes for distribution
C As requested _: Returned for corrections it Ratum_corrected prints
❑ For rev,ew and comment
0 FOR RIDS DUE __I9 11 PRINTS RETURNED AFTER LOAN TO ITS
REMARKS—___
COPY TO _ f
SIONM.
nawrar `err aui r arrrwa er,ae w aaYe.rely eaaly r m rL
.,All 10: ' A AVIT OF
I*p. S[Rt AI I hor Indust WAGES PAID
Ikparlmenl ul I�b�r A Industries
Lniplo,meu mandards Dnision WED ON PUBIIC WORKS CONTRACT
(;f al Administration BaitilloWMENT RE'CE
(ninths, to A 995 M 0 jga4
I:ao� ,ct-Ant9 NOV 2 Can CAc 045-84
ru g,Jpyh,Wb Date Bid Was D,,Y&y 4. 198A
Contract Awarding Public Agency Date Contract Awarded July 18, 1984
rie., if n-..r.,n
Date Work CompletalNo"ilbe li. 1984
Address 200 Mill Ave So.
Canty in Which Work Performed vim .
Renton. Was. 9SD55
Prime Contractor N.D. Moore Co.. Inc.
Telephone Number 235-'200
Was a Statement of Intent Filed
For this project" Yes LZ No ❑
In compliance with RCW 39.12.040 1, the undersigned, being a duty authorized representative of
P.K. Enterprisee, Inc. P.O. Box 5459 Kent, Yai9r+064-�9
irnrnna�, sub[mn.<.m� iAm�so
do hereby certifv that the following rates of hourly wage and hourly fringe benefits have been paid to the laborers,
workmen and mechanics employed by me upon the project described above and that no laborer -orkman or
mechanic has been paid less than the "prevailing rate of wage' as determined by the Industrial Statt .ician of the
Department of Labor and Industries.
List below each classification of labor employed by you upon the project described above and the rate of hourly pa%
and :,ourly fringe benefits paid to each classification.
PLEASE NOTE
It appreedees bit heel employed on this project,prmide this additions]information:name, .trat;"number and
stage of pregrexMla
Crab R.1, d Ruc of Ilwrl.
lawrl, P., Ina(. aeaenn 1..w
1-5 Ironrorkeza $18.04 $4.15
1-5 Laborer Foremen $16.16 $2.88
1-5 Laborers $14.96 $3.33
N. Alurh Addnwml Slwsn a%eArd
P.K. Enterprises. Inc.
f'c/m�gw a N.wr1
l
Subscribed and swan to before me BvA d,,, j o..�_ m,•aaa_l r T,Co
this j� day
I hueby an1Yt ihm.m+Jmrwihr.aFuua.91(Wort h.n, herons.wn
(\ I , 1� '11��j. r Io hr pevmlxg rae d.,%,meets . RCw' .39 W f n10 ha Ucen salnfrcd
t Nda Yublia in aM fw rhr Sralr d washrrynun,reaidi�
INDUSTRIAL STATISTICIAN
1 DEPARTMENT
O"F" LABOR AND INDI.':STRIES
INSTRUCTIONS: B u,u Nov 2 e
I. Pursuant to RCW 39.12.040 copies of this form must be completed by the •contractor and each of his sub-
contractors.
2. Complete this form in triplicate and have it notarized.
3. Submit all forms for approval to:Employment Standards Division,Department of I.abor and Industries,General
Admin+stration Building. Olympi, Washington 98304.
4. Mail an approved copy to the Contract Awarding Public Agency
CONTRACTORS ARE. RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB-
CONTRACTORS.This is required by law and payments can net lawfully be made until such affidavits are filed.
.tFwa+ sna...a w.a. Foul ea,u +'�•a
U.S DEPARTMENT Of VB PAYROLLW1 Buctil Butiu No-K-RIYl3
WAGE No XOUR OIVWON
(For Contractor's Optiorol Usa; See Instruction, Form WH-307 nat.
IEREr•d eorrtRRurae o•VAMM A m
`._/y) �, )�.P t7u �.. 'r:. _� roR YRQR owwM nglo:f AND WuryN _- .. - r•mFtT
OR cUNiRAC r Xo
omwrnw Ee
."C ADDRESS.AND [ WORN u TdK MT•
H MST YIRM 10f.11 Mp
SOd4L MCURITY NUMBER o f CUWFIGTION OM• d MT � ram. rpLylRp WrK• WgKnWy FpRyp{
d WFLOYEE O NOyA Yypem MON eRT T�
SeC
S3!-��• a ��Y ��, #_ • � _ ., — 1� 'tiruc N.Bo i:(.y/ �, � � �.��r
• �'/o.9U 'f-,.�
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AIIY A4iBf(1Y•Y-/eRY•RLY•eE )B PURCHASE THIS FORM DIRECTLY FROM THE SUPr. OF DOCUMENTS
U.5 DEFARIMFRT Of IAROR PAYROLL soap lu,ru Na N-•lo93
waca RD ROOR orvniOR Contractor's Optional Use;See Instruction, Form WH-347 In•L)
tlor
MaYI OF COIMIACTOR ON•U•COW""N"• NN>R6a
1'0•�� /1101[tr OR COIITMCT rp�
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W m WY ANY om M O/.. ® NOT
Y•em _— DlWCIIOId TiAYO
MYL MDME!!.AND _ vimTmALAW"M
5f 'AL•[LInMTY MYYIEP INr CUt1•IIIOREOM J HOURS or m /� Iq{pM0 oTMY EOILik� tA•a
OF EMKOYEf ■ 5 IIo1R1•Fo111®fi1G1 aNT Till
0$ 0
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r'MI M j a;1]1 - FORMERLY•OL le+—PURCHASE THIS FORM DtREMy FROM THE SUFT. OF DOLUMERTS
a, APPo,<
U S DEPARTMENT OF U PAYROLLBUR Bu4M Nurou Ma A4RlD9]
wADf AND ROUR DIVISION (Fa C wArac s opliaw um; s"Instruction, form WH—ul Inst.)
ADORE"
AMYL o1 OONfrMCTOR (M MAOOMI•RCta - _
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CONTRACTOR/SUBCON. CTOR `'(Y rJ
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �'' �' Month; Qr.,.v719L. Year: (,
Tb be submtted to the City's Project I Goals and Tiatetables as cositte,l
Engineer during the lsc week of following /�w�� in Contractor's Affi dative
emonth while contract is in progress. Price Action Plan
Contractor is responsible fcr obtaining and
submittingall Subcontractor Re rts. or per City's Plan 9.1 l
To: (same ems location of r0011ee1• Asset, aese 1 From: (amee eea Ietaaism of rssaeraw)
V,CIoR 1,F.T9.0 C' ,
This report is required by Executive O1 er % ;, Section 203. failure to report can
result in sanctions which include suspension, temination, cancellations or debumen• of
contract.
1. 2. 1. ' ♦. f 5. b.
Total total
Mc* Haura of Employment (Sec routr te) ILLY number Lust.,
v/h or of of
CLoel a• .- e. • • - sino rit Ee f y.
flu- Nie- er. In-n/ .ettI total
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(Include Area Code)
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Rev. 11177 (-Mates 6 Fecal... --Minorities c Non-minorities) pave 1 of
M.
1. M SE 1071n PI.
P.O.Box 2603
PENTON,WASHINGTON 98056
asn C ue e
NIpM2556076 ...een ✓
TO J
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WE ARE SENDING YOU B"MddNF O UrtdW UPOn"cover via the Waving items:
❑ Shop dMwWp Cl 1flrNs ❑ Plans Samples 71 Swifieaoons
copy of latter ❑ Change order ❑
ooetaa PanIry
rro. oataanenou
01
THESE ARE TRANSMITTED as chwf ,e.
` for approval Approved as submrtted ❑ Raubmtt pp._caples for approval
_ For your use Approved as noted ❑ Submd_copies for distribution
�' LI As requested Returned for co,rections ❑ Raturn.coructed prints
For mft and comment
C FOR BIDS DUE O PRINTS RETURNED AFTER LOAN TO US
COPY
S16NED_�
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CONi?,ACTOR/SUBCONTRACTOR `�1' rj
re REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Nonth:_L',t�a m 3f e Year: e 4
To be submitted to the City's Project ♦r Goals and Timetables as committed
Engineer during the 1st week of following /.` in Contractor's Affirmative
nth while contract is in progress. Pr.r. _ Action PIan q.
Contractor is responsible for obtaining and
submitting all Subcontractor Re rts, or per City's Plan 9.1 r
To: (ewe odd txatta of c'liaM, Agee, aam FTom'. illoee and lotetta of c .Wlael
C V7Y CO /10,rz.4 M.G Mo ,rC coy Ztic
'E"G,adE E.�fNL /�.c 6ex 2ac3
Qc"+r'.v City NFLC /?Eu-r A., 441A 48rSb
This report is required by Executive Order 11:46, Section 201. Vailure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. 2. j. ♦. f T. 6.
^SM1O- Total %l ei
York Hours of Employnant (3ee foctmtfl rity number unt.-
of of
ciamai A• of mirro rltr Bepby
tf1 • Ft a- Amer. Aa tan/ .c raj total
Coapany'e xame (S.t.l :rACA ttana Tota` 91ack ndlar, Retie Fir v T. eeeloY- eea
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Rev. 11/77 (-files 6 Females, ••Minorities 6 Non-minorities) Page cf
7/80 (Submittal Requirements i City's Caals,Timetables) —
1 . •
Proj"t N/E3f Pit.- �n — — CAc No. 045- 8¢
This Is to certify that the prevailing wages have been paid to
our e"loyees and our subcontractors' employees for the month
of DEC B4 in accordance with the Intents to Pay
Prnva ng age ,led with the Washington State Department of
l dar i Industries.
Caargatty Maas
9y �:X 4r/ �..
Title .L�bT. ./1G@...
M. D. MOORE CO., IM• (LIETTUO OF MA eND17"TQL
13651 SE 1 W th Pl.
P.0.Boa 2603
RENTON,WASHNGTON 98056 —
Phow2554W6 i J
WE ARE SENDING YOU p2'Adachw C U.sder separate cow via **foilowne ibms:
C Shop drawiro 7 Prints Plans 0 SKAPlaa O Specifications
❑ Copy of letter C Chanp order C:
Cann_I an w on,:Mmoe
�S 2 _air Ij All (24
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THESE ARE TRANSMITTED as checeed below.
�❑�For approval 0 Approved as submitted Resubmit copies for approval
6�'^'• your use ❑ Approved as noted ❑ Submi!_cpies for distribution
C As requested ❑ Returned for corrections 0 Ratum__corracted priors
For review and comment ❑
FOR BIDS DUE 19 _ PRINTS RCTURNED AFTER LOAN TO US
REMARKS
COPY TO
__ _ _ ... — SIGNED:
«.<m.,.....1..er n.aria airier,,,.:ns...e
W-715 WEST HILL PUMP STATION WTR-10 2
#7 Payro:l Sheet
CONTRACTOR/SUBCONT TOR `�Y rj
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' ate,�1 Month:. lc-,+<,A�et Year: =/}'S
♦(.Cps+
he cubrdtted LO the Ci LY's Project ,'\ � Goals and Timetables as committed
rnginneer during the let week of .'oilovnq r� •J in Contractor's Affirmative
nth while contract _s in progress. Pri,e Action Plan k
Contras-cr a res-er.:;.L_e 'or -.-t -c:na A,!
su mi-t•.- - --- - or per City's Plan _9.1 4
To: (ear aaa laea.lr of fMVlLrce Aa y ega.I From: ,are aIN i"atir of ewrrac.w)
CENTRAL PAINTING,INC
4749 W.Marginal Way S.W.
{ SEA^LE.WASHINCTON 9E106
This report is reeui:ed by Executiv: Order 11246, Section 203. Failure to report can
-resu.t in ,anc:ions which inciude suspension, termination, cancellations or debarment of
C coot rac t.
! 2.
4. 5.
Total 6.
aLw_ U3 oak
M work Fo'.ra of Evvioyeart Is.* footnote) rLty nuafer weber
or
w/n or ainori Em9by.
flea- ! I P.1n- �.wer. naim/ .otallta tal
Corgar�/'a ,are ,L_. .-:•a �•iona .ota:' eiatx yarlo ndi,, Pa^.trie Re- ( w/h P.myalnY- eee
_
Island ale
CENTRAL PAINTING,INC. � ' c12
4749 W.MargInm Way S.IN QeP
L SEATTLE.WASHINGTON W106 Y
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;.r:. .. .W. ce, °S,._, --Mirurities s Son-m-nor
- - Page of
Cat,' rna!s/^i nor s?:1 ns`.
U.S. DEPARTMENT OF LABOR PAYROLL
WAGE AND HOUR DIVISION (For(,'rider's Optional Use;See Instruction.Form WH-347 Inst.)
s
RAW"CONTM(TON .M SUSCONTpAGTON
`Q -IiOR FOR WEEK ENDING lJ WC_ x°IECT AN°
� :
PAYROLL NO L` )`(a>• ...r/A ...1
(1)) IT)� ED p - ) DAY ♦N:. DATE -
,Du CTION6 NEr
q RATE moss wAOE.4
NAPE.ADDRESS. AND ANICELINTEARNED : WO. TOt4 PAID
SOCIAL SECURITY MUYIER � j CLASSIIFIOAATION '-� > ;�% 'O'JRS of MY EARNED fiG NOLU:N. uN:l OTHER OE W[NbF3' !OR WEEK
M ENRDYE[ �45� O ' «uuxl wcRnEU (ACH DAY TAX
d.N7hPD 02FED l o I
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,o.wH-TET 1116F,—roRMEREY so, I,A—PURCHASE THIS FORM DN WOTLV FRAM THE SUPT, OF DOCUMENTS
Fo m APP—
US DEPARTMENT OF UROR PAYROLL RuaFel Nu.«u Nu rT-RIWI
WAGE AND HOUR DIVISION (for Co.ttractOT'S Optional Use;See Instfuctlon,Form WH-3471nst.)
4 I+UORESS
NAMr.OF CONTR4;EOp N SIINL+`nlun I(N ,y
_'F/ ..t , �1 --T3Jt�EcF'6R2oNINeerNo
rOF WEEK ENO Nn AND IOf+Er10.
PAYROLL NU AN ,
RNO CAVE Ifl I IN 14 19)
(u ISI1 OI N pf UUCT10Ns nET
e /I) T ILGI TOTX MiE ANU55 + - WAGES
N.TNL AWD AND yy WOFR 10 �' ♦ OUNT WIl In1N PrUO
SOCIAL SECURITY MUINCII �Y� WORK
_ SC�1/132�).j EIOUM MPAY I FNED FICA NUT O�IN< lr+/ I'uNIF DTNfN OIOu[NUKS I.iF WEEK
OF EMKOIEE lit'i NOUNS WURKED EAON DAY
IP.,ceA o OrCEEEo I D. I
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U qq '17�rs � � i �.la2 g.01 1471 9393
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rowM wN-au u,9ei IORNENv wl m4 PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
U.& DEMRTMEMT OF Litt" PAYROLL
WAM AMO I401/111 0XVIR M (For Contractor's optional Use;See Instruction,Form WH-3471nst.)
RAMC or CorTRAcTMM111c, A.M RUAEo«I AAcroR .• /
11
nYROLL Ro. - ,!)R wELA I
OI r h O D111 AND OaE 'D '61 n c ll,� 131 a
T'G 5 . S.M f!GJ TOTAL RATE csosa wars
MYE. A(wR[ss.ARo wMR O- ' noun, or ,AT AMOIMT ,«,M vA,R
EOOIAL SECURITY NORMAN I.AXIMArnM .2 j1.;j77j 75 :jC EARR[b reL F] nno« um�0 nA•. iu« WrIA
Or crnov" gS 6 HOUR%Now ArD EAco My
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raw ww-w n.am - .uRMLRIn suL 144 VURCHASL THIS FORM DIRECTLY FROM THE SOFT. OF DOCOMEMS
CONTRACTOR/SUBCO CTOR �(Y
� fJ� REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Month:-1 Year:
To be submitted to the City's Projett Goals and Timetables as comitted
Engineer during the let week of following r�. ...1� in Contractor's Affirmative
ymonth while contract is in progress. Prime ,ill Action Plan 1
contractor is responsible for obtaining and
s mlttin all Subcontractor Re -rts. or per City's Plan 9.1 \
TO: (same eM locallw of CGWII ce Assoc, pqc 1 From: Owe aN tocalem of amarmater)
4 iC70R t,E,1, TR C_ Loa
This report is required by Executive Order 11246, Section 103. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
.44 o
�n Ilai�- total r oral
work Hours of Employment (See foctn:tel rtt number umber
r of of
Cl anal e. e. a .. . tot of minorl Eepby.
a Xie- er. �a:an/ .aul total
C rode Ilu- lot a' black 'nC1er. h^Etc 9e• F.mpl oY- eee
CO."",a eaea (I.C.1 dons w^Ic LLo-! a.e v'b eea
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7. Copagr Cfrlelal'a Signature and Title 8. Date 33anec 9 Telephone buster
(Include area Code)
Pev. 1107 (*Males 6 remdles. **Minorities a Non-minoritlea) Pape I of
M.
1. M SE I07tn PI.
P.0.Box 2603
BENTON,WASHINGTON 98056
care — 5 "e
Phate 2554076
7 d TO ar
WE ARE SENDING YOU ttached _ Under separate cover vus the foliowfng items:
Strop drawings Prints Pons ❑ svw* e a Specification
Copy Of letter Change order u
cprsu "n 1 w Ieuewrwr
' AfS v-R
i
THESE ARE TRANSMITTED as checked below'
Fo approval -- Apptoved as submitted ."' Rewbmit—wpies for approval
Por your use Approved as noted Submit--copies for distribution
❑ As requested Returned far corrections ❑ Retum_corrocted prints
❑ For review and comment
❑ FOR BIDS DUE I9 0 PRINTS RETURNED AFTER LOAN TO US
REMARKS- _--.-___--
COPY To L
SIGNED: � c
WS
WE-ARE-CHANGING OUR NAME
You know us as M&R MECHANICAL CO., INC..
but as of JANUARY 1, 1985 we will be
NARDONE MECHANICAL CONTRACTORS, INC.
Our management and high quality service will
remain the same; only our name will change.
January 1, 1985
Nardone Mechanical Contractors, Inc.
668 N.E Northlake Way
Seattle, WA 98105
(206)633 2730
Patrick V Nardone, President
PAYROLL °
US. DEPARTMENT OF LABOR
WAGE AND HOUR DIVISION
(For Contractor's Optional Use;See Instruction,corm WH-3471nsL)
Oq SUBCOMlgACYOq nVUuf 55
NRME OI CONLg�ACTOR
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P.{{VROLL NO. T M+
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N.tNE. ADOw f.AND rr1 �q n4/ � C( I: I S _ TOTAL "It - AMOONT I WIIII. NAGE1
SOCIAL SECUA1lY NUMBEII $ .yS CLASSIFICATION C - 'I S NOLMN OF PAY c IOtK PAIN),
O! fMPLOY[f IQia"1'I �� EARNED lLLA NfI f:ING % 4,f J MA OI.t. O(WC1Mg3 FOR WEER
p'. NOUHa NOwrtf f f C�� :rhr ✓
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FORM W l uiw)—FORMERLY SOL ISE—PURCHASE TNK FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
PAYROLL fam W., 1
U.S. DEPARTMENT OF LABOR RUUtel Ournu Nn eHI09D
WAGE AND HOUR DIVISION (Fw CoFdreetm'sopflowl Use;See Instrudion,Form WH-3471nst.)
NAME CDNiNM.AN - ON 1UBEONTpAL/O�N
PAYMOV EDR YYEEN FNDIN NIIIFcr
u DAY M1NO.-IfIG, i
(I) ID Ill ff DUCTIONB NET
F.lF m f G�nt .5 oaoss wM1DEs
NANC ADONESf. AND E Eppl( Q.?E-'•�j j 1 V Iwi MtE AMOUNT I WITYR fl M LAID
SOCIAL SECURITY NUMBER figy.. CUSSI LION F .�_� P / /�/. �Y :'iiAS Of PAY Fi(PNFD FICA I NOLOIN. ��� �� IfMEN
W EMPLOYEE g�0 O NOD119 WORN ED M. DA TA} 1 U. :11'INi FDR WEfF
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FORM W 341 unsl -FONMERlY WL 184 PURCHASE THIS FORM DIRECTLY FROM THE SUPS. OF DOCUMENTS
AA. D. MOORE
• 1 C .,IN• TF MMSETTIML
tPI
03ti O30h .
P.0.Box
RENTON,WASHINGTON 98056
L P to 2553076
TO
WE ARE BENDING YOU Under separate rover eie _the following items:
C Shop draamp Pnnts Plans Samples C Specifications
❑ Copy of I,tter Change under _.
C n PATE Np
•H / -5 l) E'L 1 yrf hu Na f.CLL( �t�D 1�_ .f �?/�1•�]i_��C �, �'C _ _
urn" J/ ,�/c ;�, .l•. ,�
THESE ARE TRANSMITTED as cAeched Dhow:
_1 For approval Li Approved as au6milNd i- Resubmd__..— copies for approva'.
(,k4or your use ❑ AMm"d as noted C Submd__cup+es for distnPuton
dN As requested ❑ Rabmed for correction C Return_cormcted prints
C for review and comment C:—. __
C FUR BIDS DUE_ 19__C PR'NTS RETURNED AFTER LOAN TO US
REMARKS----
COPY TO— _.. ___
L
SIGNED:
..., ,. ..a. ..� n.Mrw....•.rot..wlw.s,wr meb...e e...
1
CONTRACTOR/SUBCONTRACTOR `�Y
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT " Month:, 1�, Year: - =
To be submitted to the City's Project ,^ 1 Goals and Timetables as cowitted
Engines during the 1st seek of following in Contractor's Affirmative
aminth while contract is in progress. Prime Action Plan l
Contractor is responsible for obtaining and
submitting all Subcontraafcr fw rts. or per City's Plan 9.1
vo: (ftr sea location of Compliance Aaesey peat From: (sees .4 lotettw of ceetractee)
11iis report is required by Executive Order i1:16, Section .103. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarmeuc of
contra^t. _
3. 2, }.
Sins- Total 'at*)
York H�ura of Employment (Cee rootnc te) rtty numtar US D er
w;'h o[ 'Of of
C lame3 e. c. • - . minor St Employ.
Mb- Z.
Daian/ .otml tOLtl
gads flea• Tota tllaek nd ien Pi=Vie ?e- Sep loY- See
Company's Same 11.C.1 tlor:a poolc pynl .ale �'D' s
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span, Offictal'a Signs .re in , e [.ate Stgnea 9 TF1etl one SueDer
(Include Area :ode'
t
Hev. 11/77 (-Males L Femall s, eeMirwrities G Non-minoritie.a Page of
7,80 iSubedttal Re,�.iirements C City's �.ouls/Tim:tablesl --
CONTRACTOR/SU BCONT ROOR Y
REPORTING PERIOD _
MONTHLY MANPOWER UTILIZATION REPORT �' Month:�rq/„�/p,e_. Year: ;S'S
To be subautted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of following I� in Contractor's Affirmative
nth while contract is in progress. Prime \" Act lot.. Plan
Contractor is responsible for obtaining and or per City's Plan 9.1 t
s,b ttinq all Subcontractor Ptt rts-
To: )tar aM I it •f Compliance essaq n+a.) From: tar mad l•sealw of arrestor)
.,gone Mechan,cai Cc . -
"ry 668 N.E.North a}%
Q 46 -Gyp Seattle,Washington;
This report is required by Executive Order 11246, Section 203. FaIngto report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
I. z• 7. a. f 5. n.
aIno- Total otal
York Hours of Employment (Sao footnxtel rlty number umber
of of
C Loal o. e. • • °� of .mart Empby-
fSc,- 11e- 1mer. A$ion/ .oL/ total Employ- eoa
Compup'a Ram, (L D.)++ tre de Lion; Tota black ok panic Cndlan R r.�t ?ale wm eea
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7• eempany Official's sisnot.re and TILI, S. Date Slanea 9 Tele9vone Number
(Include are, Code)
Z-8 bS Z0( -l. 33 Z73C%
Rev. 11/71 (gleles a Females, ••Minorities i Non-minorities) pass of
1/80 (Submittal Requirements a City's Goals/Timetables)
CONTRACTOR/SUBCONT CTOR %C Y ' REPORTING PERI'0
MONTHLY MANPOWER UTILIZATION REPORT �' Month. _,' 1 at:
To be submitted to the City'a Project Goals and Timetables as cositted
Engineer during the 1st week of following r�. in Contractor's Affirtaative
,nonth while contract is in progress. Prime N'C Action Plan %
Contractor is responsible for obtaining and
submittin all Subcontractor Report
or per City's Plan 9.1 l
To: (New, eea lacatten of rowllaace Agency D"t.) From' (lure mad . eatlen of amtraeter)
i.(+MF t Net:04.E - SJeL o.+r ta. Oc
rA 0 M OGRe CC. •Lein. - to a�eae-a-
Po_ boa Lboq 96oSb
This report is required by Executive Order 11246, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debatvent of
contract.
( 2. 3• k. t 5. 0.
Dino- Total total
Work Hcure of Employment (See footm;te) r•ty number umber
v h of of of
C heel a• o ' t ' / minor: Employ
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(Inoloee Area code)
Rev. 11/77 (-Male$ 4 Females, "Minorities g Non-minorities) Page of /
- 40 (Submittal Requirements 6 City's Goals/Timetables)
US. D[vr.R LABORTMEHT o: LABOR
PAYROLL ;;,."fw.dam ARID)
s wAGE M.0 HOUR DIVISION (For contractor's Optional Us•;S•B Instruction. Form WH-347 Inst.)
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US DEPARTMENT OF LABOR R M Rure.0 Na a-R!W I
WAGE AND NOUN! DWISNIN (For Contra<bi s Gptlonal Use:See Instroctron,Form WH-3471nst.)
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(Far Contractor's Optional Use:See Instruction.form 1!KH-3471nat.)
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CONTRACTOR/SUBCONTRACTOR �C y fj REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' �' Month: BAN, Year: J94p S
To be submitted to the City's Project 1 Goals and Timetables as committed
Engineer during the let week of following �� Ll• in Contractor's Affirmative
nth while contract is in progress. Prime .1' ` Action Plan i
Contractor is responsible for obtaining and
rAbmittinq all Subcontractor fie rts. or per City's Plan 9.1 t
To: (Hope and locatiem of ra+lieoco Agoney pap.) From: (%= ra location of comaraeaw)
�)ry OF REuro til In.D. iNGOA'E cal Z&C.
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,c>&A.�rvu, (,a..H 9a9c.•5� REMYZIA/, wA 9805E
This report is required by ExEcutive Order 11216, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
2. Y.
1 I. mina- Total rotal
Uork Hours of Employment (See footnote) rity number lumb.r
of of
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y (Include Area code)
cec rne� / 3fl B S roc 5 bo7lo
Rev. 11/77 (-Males 6 Females, "Minorities Y Mon-minorities) page of
7/80 (Submittal Requirements 6 City's Goals/Timetables)
Date! 3l-BS
Project u0 CAC No. CV5' -64- _
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of TAti/✓A1� 91" in accordance with the Intents to Pay
Preva n�{TrJ with the Washington State Department of
Labor i Industries.
M -D MUDlZo—z co, .ZNC
empany Name
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Title Seel7XF4,S
P.0.Box 2603
RENTON.WASHINGTON 98056
n
Photo 255.6076
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WE ARE SENDING YOU �j'�g yjyoMg ❑ Under separate carer va, Uy fyhinaing ems,
C Shop drawings ❑ Prh is C PM. C Samples C Spowksti
C Copy of Witter Change order ❑
taan an no. WaaemaN
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THESE ARE TRANSMITTED the chocked below:
❑ FW approwl ❑ Approved as submitted Resubmit_oopies for approval
I<For TOW use C. Approved as noted Submit_cvpiu for distribution
C As repueated C Returned for corrections ❑ Return—corrected prints
C Fee matte and command ❑_
C FOR 'NOS DUE 19 C PRINTS RETURNED AFTER LOAN To US
REMARKS_
COPY To
Mateo_L`
eearw x1Wwrr .
u.S. oEPAMiYEAfr of IA•DR PAYROLL "°°'°"'"
W4DE AND HOUR OIYI.IOn N4M isi N nu ..'Ob
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US OEPARTYTHT Or UM•DR PAYROLL
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US DEPA MENT Or 0e041 PAYROLL
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WKE MD NOUR OIYIRION
(For Contractor's Optional Us•:See Instruction, form WH-347 Inst.)
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US. MSRWEIEeEr or LAM PAYROLL Fom A Fm
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(fa Contractor's Optional Use; See Insbuclwn, Form WF4-347 Inst.)
MAIL 0I CDMItRCIOM °�a1LWDMNMWOM ADDRESS
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f� AMOUNT WITH law spurFear"m EEVIOras FARMED fIG IglO1M0 0110 EESaL10i
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U.S DEPN MOrT OF uWR PAYROLL
W� /JID HOAR LIYIBWH Wd�l BWFW Ra Y-PIO])
(For Contractor's Optional Use;Sa•Instruction,Form WH-347 Inst.)
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us u•D•
PAYROLL
w... MO OUR umarou
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r MEHr Or u•on PAYROLL Fo m AD"
w4 t AND NOUN NIV�a1M1
(for (;oniraNur's Optional Use;SM Instruction, Fdn.WF{-317 InA)
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CONTRACTORJSUBCONT OR Y f- REPORtING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' f�' Month; /;�•ry(,,, Year:F l'"
To be submitted to the City's Project 40 Coals and Timetables as committed
Engineer during the 1st week of following in Contractor's Affirmative
nth while Contract is in progress. Prime Action Plan t
Contractor is responsible for obtaining and or per City's Plan 9.1 t
s tin all Subcontractor r s.
To: (Core sae lecatlr of Can*11 ata Aarcy p<p 1 Prom: jasae and 4141WRI — MI":--
p a Box AID
RENTON, WA 9805E
IIC. rMO M0-01•021311
This report is required by Executive Order I1246, Section 203. FaiillTe to report can
result in sanctions which include suspension, termination, cance'.lations or debarment of
contract.
1. 2• 3. a. It 5. a.
alno. Total Petal
Waft Hours or Employment (See footnote) city nuror umbor
of of
Clasal a. <.a .. w/h of at of
Employ.
• XU_ hear Ae tan/ .oul total
Corpany'a Eue (t.C.) grads flea. Tota Black ndlan rxvie f<- Faploy� saa
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7. Cc- cfrlclal's nlynat:,re an u . Wte Signea 9 Telephone Lumber
(include Area Code)
Rev. 11/77 (-males c Females, --minorities L Non-minorities) Page of
7;80 (Submittal Requirements a City's Goals/Timetables) —
Data:
Project N/Ey% Neee CAG No. 64-T—bpi
•5n�+n
This Is to certify that the prevailing wages have been paid to
our oweloyms and our subcontractors' employees for the month
oft244. 11-14Cr*/`/�S—In accordance with the Intents to Pay
Pravalilny woo filed with the Washington State Department of
Labor G Industries.
romp—my I Nave
OY /��_2 h �• A )7�e,�ii i�
Tltla iC�sFdFxJ ! /l101✓.'F _,SFI�..
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M. 1 52 SE 1 7th IN• LmirirA COIF irmi�G9�G�d uinja
13652 SE ]071h PI.
P.0.Box 2603
RENTON,WASHINGTON 9BO56 —
Phone 255-6076 ^r•^
K
t0
I
WE ARE SENDING YOU A—KhaChed Under separate corer via the fellowtng Hama:
Shop drawings Prints ❑ puns ❑ Samples ❑ Spedflcatiuns
Copy of letter Change order ❑_
C..Aea DATE XO DESCepneN
THESE ARE TRANSMITTED as checked below:
1-1 For approval ApprovM as submitted Resubmit copies for approval
44
�t For your use :_ Approved as noted Submit_wpies for distribution
❑ As requested ❑ Returned for corrections Returncorrected prints
❑ For renew and comment
❑ FOR BIDS DUE 19___C PRINTS RETURNED AFTER LOAN TO US
REMARKS__—_.._._ _.
COW To— ___ i•
SIGNED:
maw ro. ern.�.�.A. .. M w1ralWro oe na..net.e.bewr wnry u.of ez..
U.S. DEPARTMENT OF LAWN PAYROLL F.—"P°'°`°°
WARE AND HOUR DMSION aueEM eurew Nw u-RL09a
(For Contractor's Optional U.e;See Insirufiion,Form WH-347 t1ME)
/ ' ROORfSS
LL NO. E _ C RI we CT OR
NAYE OFCONTRACTOR OR"SCONTR"c OR n
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P�LL NO. I iqf WE[K ENOI ) � PRI.IEC�T/AND/��pE�A�W!a�/�J C' IfGT OR/T)lI1MCY Nrt
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SOC4ll EECORITY MUMMR a ' EARNED WIiH I tOTX. N1b
ClRE81ElUTION 3/_/ z .mil_q S �• NOUR6 OE RAY EARNED .If..T NOLOIN4 L/�t- ^ OTHER
Or,EMPLOYEE �� O HOURS W"rwNEO YACN Uwv TAX
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FORM b 347 UI6e1—FORMER" So,TM--PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
k
US DEPARTMENT OF LABOR PAYROLL N„avl Ar,.....rw w-pID03
WAGE AND HOUR DIVISION
(for Contractor s Optanal Use;See InslrlLc(wn,form WH-347In5t.)
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MAML �V C�IMINA 11)F � fW SUflCONINwCTOIf
FAYNOI 1 � FnA WEfF INWNL i �f/�// " � IrT yIl i,UMlNwfl Nei
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'CONTRACT OR/SOaCO%7WOR `� rJ •
IIEPoRTING PERIOD
MDNTM,Y VWPOVER Bi ILI:ATION REPORT Month: G c A Year:
job be submitted to the City's Project Goals and Timetables as committed
JEMiroar during the !at weak of following in Contractor's Affirmative
lmonth while contract '_s in progress. Prise .N Action Plan t
.- resporaible for obtaining and
Svbcontractcr qwports. or per City's Plan 9.1 t
To: (ANtA ane iatatlaA Of fWOeltanca A@,My 0", From: ( mr aaw loemlom at aatrMtee)
CENTRAL PAINTING,INC.
.7.T W.E. rA SmjNgl" ro s.e,
SEATTLE.wABM.NGTON 90+00
is report is required oy Executive . r 1 ♦6, Section .03. Failure to report can
result in sanctions which include suspension, Termination, cancellations o- debarment of
cant. -t.
jz. f 1. .. o Setal a rots.
f wcrx :.-_» o! la^,iereArt Ian foetro r1tytal rity Or muab.r
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CENTRAL PAINTING,.NC. �.
47e9 W Nafa,�+ War s.W
SEATTLE.WAStiINGTON 99t96 +
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CONTRACTOR/SUBCOIi'i' OR ` Y REPORTING PERIOD
MO%THLY !UWPOYER UTILIZATION REPORT Month:
be Submitted to the City's Project Goals and Timetables as committed
&Kinlaer during the ist week of following :. in Contractor's Affirmative
nth while contract .s in progreas. Prise Plan �
Cor,tzactoz is responsible for Wtaini»g and
s4kamitting all Subcca- .actoz Re z s. or per City's Plan 9.1 A
To: (mae mtd leeaelea of ONP&Ia apaq sgt.t From: (awe eae leeettee of Mmerater)
I CENTRALPAINT�NG,INC.
049W MWgiM'Way S.W.
SEAT LE.WABNINGTON 9slea
.,is report is requ;r" by txecutive Order 112A. Section jw- Failure to report can
result in sanctions which include suspension, tetminat-on, cancel:ations or debament of
contratt.
eino. Tecal tal
Hours of Em9loramt (See feotmote7 titr numEor !tr
a or of
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U PAYROLL
WAGE DEPARTMENT OF IAROR Bualel au.eAu No a-Rlofa
WAGE AND HOUR DIVISION (For Contractor's Optional Use;See Instruction,Form VIH-3471nst.)
NAM[ fl1 ClIN1NAI fUP 1 � UN SUBC(INLNAf.TVN �! ry/, /1 AUUfl E55 /c �/A �/�
I FOR WEER ENDING J�.\\ �' IICT NI N _ T/����"""Jlgf�cEcc�� CpN1RACI Nn
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US DEPARTMENT OF LABOR ewAH Ro.nu No a-NIOIT
WAGE AND HOUR DIVISION (For Contractor's Optlonal Use;Seelnstrudwn,Form WH-3471ns1.)
NAME UE CONTRACTOR OP MIPCOXTMQOR nImNIBS
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PAYROLL NO. �fOR WEEF FI�INC ROJECi/GNU LOCATIOy, 'F!IllS. OR'CDNTPACT Nll _
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U.S. DEPARTMENT OF IAROR PAYROLL RudZKI R..•«ate Nn++--R1M'
WAGE AND HOUR DIVISION (For Contractor s OPtSonal Use;See Instruction,Form WH-3471nst.)
P'S5
NAME Of (:On LNrI1:IUN ON SURL(INiNACTON
OR WEE% [ NG 1 p OIC`CT AND 1 All cJ /. PR ll[1 OR COWf
PAYROEI NO. M/7/
91
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NAME, ADDRESS. AND WORK D P ,'OTA, Ra«E AMOWR WON
SOC4L SECURITY""am ,B� '-0 17 OURS Or PA. OTNER 1.114 VAID
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CONTRACTOR/SUBCORT TOR Q Y
(J� REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT U Month: Year: F
To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of followinq �. �• in Contractor's Affi ruative
nth while contract is in progress. Prime �� Action Plan t
Contractor is responsible for obtaining and
submitting all Subcontractor Reports. or per Citv-5 Plan 9.1 A
'10- (aar and lotatine of raeoliente Agency 0"t.I From'. Isere!W0DiM"REoOK4Wrecteei
('I�tl CA- %F.vrc»�V P.O. BOX 2603
RENTON, WA 9M
LIL. rM0 MO-01 *22331
This report is required by Executive Order 11246, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. z. 7. a. % 5. b.
I
ino- Total otai
work N:urs or Employment (see footnotel rity nun bar caber
or of
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company'* Name II.1.1 'rade ttons tote Black pa ni^ ndlar hetRe Y'
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Rev. 11/77 (*Males g Females, **Minorities g Non-minorities) Page L of L
7/80 (Submittal Requirements i City's Goals/Timetables)
Date:
Project _ CAG No.
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
Of in accordance with the Intents to Pay
Prevailing filed with the Washington State Department of
Labor i Industries.
Company Nava
9y µ'Z I
13652 SE 107th Pt.
P. O.Box 2603
RENTON,WASHINGTON 98056
Phone 255-6076 -
To
WE ARE SENDING YOU VAAttachad Under separate cover via__.— —_Ms tolbvnrq Remy
Shop dmwings prints plans "_' Samples ;_ Spacfiations
Copy of lettar Change aide, _
cpMea Date ad oCACANr10r1
14
THESE ARE TRANSMITTED as checseq below:
For approval Approved as submitted Resubmit-- -copies for approval
[S/rr" your use Approved as noted Submit---,copies for distribution
As requested Returned for correctors i:i Return,_portect-d pants
r, .
For mwew and comment _
FOR BIDS DUE 19 p PRINTS III TURNED AFTER LOAN TO US
REMARKS
SIGNED: .�D.zE':s./7�• f/(�'�+'L<�
'�'�'l.�rw eY 4 YV Ir M[Wa'/ar In MI��MN lrrr/r M111r ur N MM1
CONTRACTOR/SUBCONTrACTOR Y
MONTHLY lVNPOVER UTILIZATION REPORT �'
fJ�t RE_P9jkTING PERIOD
♦ t Month: J�/�e<, � Year:
To be submitted to the City's Project Goals and Timetables as committed
Engineer during the 1st week of following r� in Contractor's Affirmative
month while contract is in progress. Prime Action Plan 1
Contractor is responsible for obtaining and or per City's Plan 9.1 !
submitten all Subcontractor Re rts.
To: (sr ed txettes a! G+l/aee Assay, aqt.) From• X ! ree n
ftS lJ4 ACE tt- ��a� ract"k Inc.
ff6 N.E.Northlake Way
Seattle,Washlngtton 961D5
This report is required by Executive Order 11246, Section 2US. allure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. 2. 1. Y. Z 5. 6.
mine- Total rotal
Work Noun of employment (9•a rootno te) rity number .saber
of or
C laeei a. 0. • • w/a of minort employ.
flu- • RSa_ er. Asian/ Otal total
Company Nae (I.D.) Trade Clone To to lack Pan lc MSen rer,L'Se Pe- w/h asilor- eu
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Rev. 11/77 (*Males t Females, •eNirorities a Non-minorities) Page / of
7/80 (Submittal Requirements i City's Goals/Timetables)
U.S. DEPARTMENT OF LAWN PAYROLL Nws.L s�....I Xo u_n IDs:I
WAGE AND HOUR DIVISION
(fw CoMTxtw's Optional Use;See instruction,Form WH-3471nst)
N/.ME w OR 1U
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U s DEPARTMENT OF LABOR PAYROLL „, ,,1,,,..•.., ., F, ..
WAGE AND HOUR DIVISION
(for Contractor's Optional Use;See Instruction,form WH-347 Inst.)
Haut Oi L'pNlRACTDR OR fJBCONIRRCTOR Itbxt /
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SOCMI SECURIIV NUYBG lid IUSSIi ICAIII)x �; r C /j ( /� OVNs +r{ nNr >• '
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U.S. DEPARTMENT OF LABOR PAYROLL
WAGE AND HOUR DIVISION
(for Contractoi s Optional Use;See{nslruUmn,Form WN-347 Inst.)
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U.S. DEPARTMENT DI LIBOR
PAYROLL
WADE AND HouN DIVISION (For Contractor's Optional Use:See Instruction,fwo:YY7/-34?Inst.)
Rf 35
NANL Vf UInTRAfT(IR OR aDncDNTRACTDX SL+attle WA 98105
ti68 N.E. Northl.nice Way •RNeranorrdl ornn e Mechanical Contrdc tors,
i ....1,1 I.W.ACT No
I... West Hill Fimi Station #115 H
Ui Iz�� � mcnoNS uEr
60.11
MANY ADERrss. AND o g. y/{1RR .26."� .2829 3031 1 roT11L XATC AuouRl WnTM Ima "RIY
gDIlA1 SICIMITT nUNNCX s NOVRS Vf •A'1 VTNFR VI ODENOM1S iVR WEfR
CEAssIr MAtron S �1 T W Tki Y S EARnrT� nu NDiA.
I), EmmoY[C g��'. O NVIMS WURR£U LAT 11 VI,vKnud -
.Journeyman !°
531- Hansen 3t,.63
531-40-1934 �—' 1.97 ----1 :9,3;330.03
* 1'e ,11 ,:'S 489.38 34, 9.00 ,61.88
19028 30th N.E. �A.1 Plumber --- -- - 11- '-'- -
• Seattle, WA 96155 - 1
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taw wN-.MA Ivnm SUP! OF UUCUMENIS
IuXNfm, sw in; PURCHASL THIS FORM DIRECTLY FROM fHE
CONTRACTOR/SUBCONTRACTOR `IFY
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' �� month: ffP/r /z Year: Rs
To be submitted to the City's Project t Goals and Tieetables as comitted
Engineer during the 1st week of following �� in Contractor's Affirtaative
nth while contract is in progress. Prime 'h� Action Plan Y
uintractor is responsible for obtaining a,d or per City'S Plan 9.1 1
submittingall Subcontractor Re rts.
To: (Was, sad Ixallcw of G+Ilaeca AAry ear ' From. iaye t( �araeewl
/r/ OFjlfdr0✓ P.0 BOX2643
l,Lh�iNEf.C�i+Va N MD MO�
Ll 1-.22731
This report is required by Executive Order 112a6, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or deharmert of
contract.
1 2. 7. •. 5. b.
m inc• Total otal
Work F,s of Employment (=ee rootwte) ritY number weber
of of
c laaal •. C. • wrn or minorit ¢mpby-
flca- a Him- er. ;Ilan/ :cal total fm to eaa
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M1I ni role
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(Ir elude Area Code)
nv. 11i77 (-Males G Females, --Minorities G Non-minorities) Page of
180 (Submittal Requirements a City's Goals/Timetables)
RECEI'IED NAY Q 2 '-85
Date:
Project WEST f/,LL POMP GAG No. GYS.l�
5>A n OA1
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of f;f%'iL '✓^.' In accordance with. the Intents to Pay
Pre-1A.j aq�e iT.d with the Washington State Department of
Labor i industries.
Company Nam
by t2LGa• 1�/Bsu
Title Sec./TAs.
i
CONTPACT7R/SUBCONTRACTOR
REPORTING PERIOD G
MONTHLY MANPOWER UTILIZATIOd REPORT L" JT� Month: �.�F Year: O S
To be submitted to the City's Project ,rl�j Goals and Timetables as coasmitted
Engineer during the lot week of following F"N�Lp in Contractor's Affirmative
month while contract is in progress. Prime Action Plan
Contractor is responsible for obtaining aN or per City's Plan 9.1 t
submitten all Subcontractor Re rts.
10: (ROOM aul Iocatiml of C40VI iance Aaemcy DO",) tl 60 Fum, 1 n W /seatlew of e�traea w)
//// dr 1Bc en Cal Contractors, me
cam 668 N.E. Northiake Way
Seattle,Washington 86t05
This report is required by Executive Order 11246, Section 203 eai ure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
contract.
1. z• ). r. % 5. 6.
Mn.. Total total
Work Hours of Employment (see footnote) rity ^umber umber
of oy.
f
Clensi a. c. . • u. k/h of minors Fmpb
f lcs- Xle- er. Asian/ 041 total Pmploy- •ee
Company's Name (I.D.) Trade dons Tota Blacka •n
panic alon PaeM Pe• wT Bee
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11neluae Arn Coeal
Rev. 11/77 (-males c Females, eeMlnotities c Non-minorities) Page of
7/80 (Submittal Requirements s City's Gools/Timetables)
M. D.M WE CO.,IN.
13652 SE 107th PI.
P.0.Boa 2603
RENTON,WASHINGTON 98056
Phone 2554076 •^'"'^"
TO
cq t
WE ARE SENDING YOU a Attached Under separate cover vu the/ollowhy Rems:
C Shop drawings -' Prints L Plans ❑ Samples O SpeCRigtkne
C Copy of letter Change order Cl
fA%[e PATE, MO. Ml;*11"rJM
of
THESE ARE TRANSMITTED as checked below.
1 For approval L-. Approved as submitted Re ubmit_.copies for approval
For your use L Approved as noted .; Submit--copies for distribution
As requested L Returned for corrections 0 Return comcled pnYKi
i_ For review and comment C_.__— _
❑ FOR BIDS DUE 19_❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS--
COPYTO__. _._.. __._.____._ _ —.____.— /
SIGNER
iesa.r.r'lim....... n.n.rawn..n iwr...or.a, u.wv.0,...r
Fwm APMa.ea.
PAYROLL °"°"'°""' A...-NIM3
U.S. DEPARTMENT OF LABOR ,fOFT WH-947 iRAJ
WAGE AND HOUR DIVISION (For Contractor's Optional Use;Fria last
♦nfiRLSS
CEO
NAME OE CONTRACTOR UR°UBCONtRAR --L_A LEj1O Rj
668 V.E. Northlake Wdy _ Seattle MIA_ ct-Ou corvluncl w
s Tnc ' "OjFCt MO LOCATION M7]5
sa ` -FiSR wEE 6"hormo-8- West Hill Pump Station _.—_.._- . „9)
Ndrd"I Mechanical contractor
PAYROLL NO. 1 6-8-85 "I n1
� y w DAY AND onrE nI
Dui pfDUCTIONv NET
In �1$'ey11 m w S M T W T F S GROSS wACEs
3 TOIAL RATE AMOUNI WITH U0. On I PAO
NAME ACORESS,AM r, WORR 2 f3 4 *5 6 7 8 HgIR° OF PAY F/�RNEU EICA NOt DING R( A,OOEUnNs I..WEEK
SOCML MCUWTY NUMB" Cl A9SNICATION YAS
3
Of EMPLOYEE �g.� � I N011R5 WORXF.0 NCN DAY ,
_ � 0��� 5 1
Knud Hansen I 1!-
Journeyman I ! 299.55483.45
° 99.00
531-40-1934 .' 1 I ' �_ 1 5 1,21.75i783.00 1 55. 139.06 116.35 ----
19028 30th N.E. 3M Pllunhes f___-'. 5 --} ! j
Seattle.. WA 98155 .� `
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Us. DEFWATMENT OF LASOR PAYROLL n.....r
WAGE AND HOUR DIVISION
(for Contractor's Optional Use;See Inst:uclion,form WH-3471nst.)
NAME of PORVRACWR 71 OR S• OMB/r"ux
_ -.isle, W1
Nardone Mechanical Contr,,C',,' Inc. R.R N L. Norrhl.,hr• Ir..� - oft 10
- ��.-an. r�r�-a..
PAYROLL MO. -
4w c,-:9-t55 6.ea 1ii11 I'uml, -tn lic,u p 715 wi
U: 17, a Owr Af10 OAn H
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NAME. AnoxEss. ARo g g M T4W THP S rou! i. ,xuu :Fs
♦MOUNT wim Ima
sw:u! sEcuxnv RUMxR Ai .n��ry 23 -4l 5;2627 2829. Homy ua�n' E.eNEn nu xmoin•. "rnr iu-urx wErx
Or FMIIUV![ gi� ryUURS wDR1R0 EACR MV IA.
Knurl Hansen u� Jr,uI Heyman �'� -
1,31-40-1934 i - 65.25 `
19028 -loth N.E. x _-..-_ --------- 3 21.7-%70.03 61.34 169.0. 110.0 7.6ti '.S-{K.00. �"'2.00
3M Pl uud N,r
Seattle, WA 98155 -
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• row Rn.J1i i.iw--10 MENLr EOL I" PURCHASE THIS FORM DIRECTLY FROM THE SUFI. Of DOWAIENTS
CONTRACTOR/SUBCONTRACTOR tC 1' rj
�. REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Month: i,pq Year.
To be submitted to the City'a Project ,e ` Goals and Timetables as comitted
Engineer during the 1st seek of following , in Contractor's Affi.Taative
mh while contract is in progress. Prime Action Plan 4
Contractor is responsible for obtaininu and or per City's Plan 9.1
submitten all Subcontractor Re rts.
To: (Rea, and Iacatir of covitrce k~ Dept I rrom: fare sad Iwattr of taamractwl
&:Ty SS086 YR NOla3b
0 E09Z XOI d
ONl AMIBgJ 3IOOrI N
This report i5 required by Executive Order 11266, Section 203. Failure to report can
result in sanctions which include sus_nension, termin.tiun, cancellations or debarment of
contract.
1. y• 3. N. f 3. a.
ttno- Total rotal
York Hcurs of Employment (See footnote) rity num➢er umter
u of of
C 7asa1 a of xlnorit Eepky
• kte- ur. Asvan/ .o tal rcTSI
Ire:e Tica- Ta to PucY nd un Faetne .e- Fmploy- eea
Canpany'a Rant (I.E.) .Sono pardt Ialtft .ale
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7. CcnWnY 0 loupe .,ignature rn a ate S,gr, S. 7,'*otone rcm➢er
/ ✓� < / __ (Ine'udt Ates Coda)
Rev. 11/77 (-males 6 Females, --Minorities G Non-minorities) Page of
1/80 (Submittal Requirements f. City's Goals/Timetables) --
Date:
Project %C'e rJ,41 !?+mf CAG No. :;✓7-,QG�
5his Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of In accordance with the intents to pay
p re vai Inq Yage% -led with the Vashington State Department of
labor t InlustrIes.
apaa
By ,1� )d.L' .cc-
Tltle 'u'.0
CONTRACTOR/SUBCONT CTOR ��Y �J REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT Month; Year:
To be submitted to the City's Project Goals and Timetables as comittea
Engineer daring the 1st week of following �1' in Contractor's Affirmative
nth while contract is in progress. Prime NT Action Plan ►
Contractor is responsible for obtaining and
submitten all Subcontractor Re arts. or per City's Plan 9.1 '1
To: (mer aN locatfea Of 0401i ce aaeaq oeyt.l From: (o,m, aad )Deer toe .f ceatrettw)
A,.-,
-as ♦eitt #,r ,e.rL !
'WA �CSL'tC `�I
. qs,
This report is requued y Executive Order 11246, Section 203. Failure to report can
result in sanctions which include suspension, termination, cancellations or debament of
contract.
4. % 5. 6.
( mine- Total total
ClNa .0 /✓L:d GALL York Your, of Employment (lea footnate) rity number •Der
Cloe,l •. c. . . w/li o[ mlrorit Empby.
' flea- • Rle- er. De lan/ :oral total
Com pany`e Same (I.C.1 Trod* tlpn, Toto a &ck panic ndlan Pastne ?e- a/h eaeloY- <ee
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(Inalaea Area Code)
Rev. 11/77 (*Males 6 Females, **Minorities 6 Non-minorities) Page of
7 an (submittal Requiremnts a City's 7—als/Timetables)
US
OFRAmMENY OF u•oR PAYROLL
NSGf AND NDUD DIVIyOM Ru4M a.. `b �Rl W.
(For Contractor's Optional Us•; Sw Instruction, Form WH—iQ InsL)
E O/COHfRADra• El ADDRESS
`LE9/' � .✓IerOUF L.y✓sR:uvl � y- _-i n�.E . /9"•
rlii•oLl No. rD•EIUR aiorNo "-/ 24/
NAhIL ADORE59,AND `{r` AJ T 4'1 7 lip Iam ORN•• °mU�10�, _ RAISINS
•EDYRIIY NUMBERCLA TI011 O NYURS w wVIVI•Rpm R
°R OIPIOYQ O MOIM n01•{m fI1C11 DAY TMl CIS° m wax
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FORA n y it/sel-. FORMERLY•OL IM—PURCHASE THIS IORM DIRECTLY FROM THE SUM OF DOCUMENTS
}
M.D. MOORE CO., INC* LIE=9MIF 1TURW W e6UN9 U L
• 13652 SE 107th PI.
P.0.Box 2603
RENTON,WASHNGTON 99056
o.n +oe
Phone 255.6076 •^<"* —
TO _ / e
WE ARE SENDING YOU iANackW 0 Under separate weer via_ the following items:
❑ Shop drawings C Pritds ❑ PNm ❑ Supplies Specifications
❑ Copy of letter CI Change order C
cones pan No.
G.
/i j u
/1 It Ia
E yq —
5 •• r, y< 4
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THESE ARE TRANSMITTED as chested below:
❑F.F r approval ElApproves" as subm ted : Resubmit copies for approval
r your use Q Approveo as noted Submit— _copies for distribution
O As requested C Returned for corrections c Retum_tomcW pants
❑ For review and comment ❑ .__.
❑ FOR BIDS DUE 19__ _❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS— --.—
n
[JUL 2 b 10:5
COPY TO _-- —
SIGNED
ar.. .I ....,. a.ne,ewmnn.a.unne.way u.n.
CONTRACTOR/SUBCONT CTOR `C Y rj
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT �' �� Month: 'Jlr Year:
To be submitted to the City's Project Goals and 71(metables as committed
Engineer during the 1st week of follewinq r�,` l' in Contractor's Affirmative
nth while contract is in progress. Prime �� Action Plan T
Contractor is responsible for obtaining and
submittingall Subcontractor Fe -rts. or per City's Plan g.l
To: (am aaa ImAAtea of Cayllance Amwcr OW 1 From: (aama aed leceefaa sf caI&trecaer)
�.Iy lnT-w CENTRAL PAINTING,INC.
7 i e149 W.Marginal Way S W
SEATTLE WASHINGTON 98,06
This report is required by Executive Order llZ46, Section 103. allure to report can
result in sanctions which include suspension• termination, cancellations or deba went of
contract.
1. 9. 3. k. f S. a.
+tnu• Total .otal
Work N:ura of Employment (see footnote) rlty nuaiber uebe-
v/h of of of
C Leal a• c ' minorit E.e ploy.
t Sca- a Nl;- are 1e1an/ .awl total "ploy- eI
Conparty's Ae^.e (T.C.) -ra Ce Lion; iu to Elaci panic nCiar. ?ecL1r Pe- v;?. eee
Te7mrl -a l�
CENTRAL PAINTING,INC. c Z z
U49 W Morg,nal Way S W A
SEATTLE,WASHINGTON 98106 rr
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ecmpenr orriclav, ai8m.ture And 7,itle r. :ate Signee o. ;ele p".c ne I:wber
(Include Area Codel
xa�yl iC LT iz, L"'•.i
Rev. 11/77 (-males 6 Females, "Minorities s Non-minorities) Page of
7/80 (Submittal Requiraments s City's Goals./Timetables) --
CONTRACTOR/S. t-N
I�
REPOR?:9G Pr_RIOD
MONTHLY NA.RPOVER UTILIZATION REPORT Month: Year:/9b tTo be submitted to the City's Protect GoalsandTimetles as committed
Engineer during the 1st week of _following in Contractor's A«irsative
nth while contract is in progress. PriAction Plan
Contractor is responsible for obtacninq and
submittingall Subcontta^tor Reports.
or per City's Plan 9.!
To: (we wM !ecation of Gmwltente Aavacr mart.) From: (new WA Isrea of egotreet.ev
� 1 ;may = (0/ �� . �vf��y, dCd
is report is required .y Executive Order 1124h, section 2,,. . .ai.ure to retort ca-'
result in sanctions which include suspension, termination, cancellations or deSarment of
contract.
t.Ll,tl2al � 1 3. r f 16.
,.
a lno- fete! .atai
,y Yy M Were Noun of Employment (See faetncca7 r%;�. �nu-. " j.va^er
c= 1 of
IN+t�v/C✓wd' S'� a L Clans•_ •. o. f .• v/l+ of'airor!tTen DIP7. .
i!s- er. As ien/ .atil •otal oar 1 met
Cos a Fame I.^.) ?rase fione tote Hlac': rznic-rdian�iweYlr se- v Fees%Deny' ( .ions
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Area Code) )i
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es, ••riitaritiee 6 NOn-minOritiu_.
CONTRACTOR/SUBCONTRACTOR Y
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT ��1 4onth Ng,' g DEc Year:196G
85
To be submitted to the Cit^'s Project Goals and Timetables as cosmiitted
Engineer during the 1st reek of following in Contractor's Affirmative
axonth while contract is in progress. Prime � J .Action Plan %
Contractor, is responsible for obtaining and a
subm:•tin all Subcon r cto rtz. or per City's Plan 9.1
To: (host All Iaeatla of rlltasco A@NW DWIM from: ([isle wed location of eaetrwtw)
City of Renton Parker Henry Glass Compal,y
West Hill Pump Station 2335 5th Avenue
Renton Metro Seattle, Washington 98121
This report is required by Executive Order 1114'1 ect tan 203 Failure to report can
result in sanctions whlc! include suspension. termination, cancellations or debarment of
contract. _
a• y S• e.
.Inc Total r.t.1
work Hcurs of Emp:tynent (Fee footnote) city numb- u .
v/h of of of
Jlaost s. c. • • • ni norit Eepby.
H le- mer. Re un/ ,atal total
Conpany's time (L".S "-a!e flea- tots Black 'ndlan fett^.e ?e- Fep1oY- see
on panic telend .a1• r'h eel
Parker Henry Glass Gla C
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(Inelude Area Coda)
(706) 662 2200
Rev. 11 77 (-Males L Females, --Minorities g Non-minorities) Page of
's Goals/Timetables)
L F— wmA
eueEw eutiu Ma aFRloal
U 5 DE Of LA80R
' WnaE ARD GNO HOUR OWisioR
(For Contracloi a Optional Uu:See Instruction, Form WM-347 Inst)
EtlME Or cmnRACTOs —J oR suecawreACiat 2335 5th Avenue Seattle. Washington 9k1 1
PARKER ttI:NRY GLASS COMPANY �f7AOIKl�OOnFRLCT M0.
-----_ rd1 wRR YWRIe reWe4T Ass)LeGTMN
rAr00u nP ,ianuary 3. 1985 Jest Hill P Station p715 -Renton Afzport e84-34
m a a
---- m m oar Ana an m M ORDUCrgnf ner
! C GROSS 111401111111
MME M)OREss.AND w,+R lI TOTfE lure miouer lmfflo� Ind. �•�• Falls
sOGRL f&cuRnr Rums" a aw ZTIOR Hpin{ w tRr EARHEO rlrJt M Ins dues 0rt1Y fflY mn"m
0r 11RE01EE $!i o NpIRE NONt®tI1EI10Ar
523 40 2427 0
John Robinson
7506 Fast F. a e 17.R4 142.72 9.56 3.00 2.40 2.32 125.44
Tacoma wA. 98404 M-3 GLAZIER
• 35 46 003B o
Roger van Court
7006 W. 35th
:acomar WA 98406 S-0� GLAZIER 6 8 B 3 8 6 H 52 3/1-17.84 941.06 64.05 210 00 15.83 15.30 305.1 635.8
552 29 6198 _
Romeo Sefq 91.8 267.69
4BI5 S. Graham Is 48 359.52 24.52 39.00 14.40 13.92
ew_attln__ Wa=htnal
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retll wr4aq n/611 - fORMERLYLr pRCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
STATEMENT OF COW FIANCE •
Dete C
(tj That I l- ,m MMe varam apinYwd Dr 2�.r. i4h `-'_•'�r_nn
'he�•� that datgp wl,iwtirnAl IaYlod o tma•inY f(,/'y� 1
I9 v.'and i a b•.].=d f ��4�XL--- to�'� mli vnam •mP19ys11 ml Esxd 4 1'a-t I a Y•,D.cn44 thI,fall
�i R - ,ha n 1 ...Y h.,r lean a.rill be mnl, e,ehe.dlmullX w.lraE.e.rsr o n 41a1,/ve,n
RErK.�Gfe � fra:n rbe(ail veNtf kaRop abed M onp ve van ,pal dMur duns pave
the lull ra R..a ommlld la anY f. .oe,a*a,than Pa •1, +LI, dtt ntoma.a defaM
In Regalrt a Pee 3 G9 CF R S Mlil• A).bsaed he*a R retry d L«por m,det I a C Iaad A", a.amaede,l Wh 510-
yA.nd&at ipR.J2 Stat-96 1 rl:+•..35t ip U.&C..2760).«Ad de.e,m..d bebw:
IAl That w�a Wr.m h. h .ade ab t ncl r.R 1 1 l a -. .wva"I"Ilia< ai.:amfpLla
,,,at the.0 lea f.4Dv,am!w mecheal _n. tAad the ut err null } c. ,l c4rapM we[e I.W.
n d n nY
mate dwbicaaLLwa uu-o,poneed low the .eat r-1.tM1..l MY claasdt mug I nhero,n fw eah lab vet o cane r
lone rich Ne work be
tdl Thai am apprealatea vmWi ad is the aDare fariml are dair redishomd Al a hone fide a n•ntit sb
rich a Sal` aPFreaelceabW-Xe Y•eeeRnla"Iry die Rae of Apprentice rtn �entitYrti-i
ahiv emf Tn prnR t e<I& raa Drpa. ,m al
Labs, w of no aucf m b,.'tcAl aiemX a tie. n.Stile c retiro-raa!rpM1 lhr Rummu E Appro,uorh,R aM T.+n Vaa,wd
Stutea D.twnn,..,;,.f 2ADw.
(i) That:
WIIE RIN(P RENEFITS ARE, PAID I'(, APPRIAEO PLANS. F"DS. a PROGRAMS
7ddim to the ea.sac 11 Aly waa ll—yu,d tw,each^t -a mecMaw listed m the lb r eL Ac-.ed YaY-
'IL paymenes M fnoa,.ba Alt paw.contract tart peen as will l.e made ll"fa pr'ala....ma
Ism Me Mnefrt of wrh ampleYtm,ernnRl as need w Sre",+n i ,)helorr.
(b: WNERP fLUNGE RENF. T!ARE PAM IN CAMI
. '£:)(LaboAlt—mo Mm+-Iaaad At ttn ab,wt rnfnrepcedwara+I{pas perm Paidrr ad.,,.ad w me paym{L as
:cant mrt to an d:ao the a" if 11. Pph-4bfw Mow h,Atthr a.,,a rrio Plas we rxiaail at ibe!V'LA,,d In
NnefaN.aa 1wed in Ohl-raa".0,4n"I rA Aottd In nm lmn n6e
(�I E%[EMIONS
ICRAFT)E%CE IION
EXPLANATION
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,rtaRGgwMM I6RR!4\+MN IR�i pX . N1g3a -
U.S. DEPARTMENT RueEa Ou.uv NR Ea-fllon
WAGE AND HOUR DIVISION _ . .
(For Contractor's UDUsnel Use;See Instruction,fwrN WH-3471nstJ
-- —
NAM[ Of CONIRA[N9 OR RUBCONCAACiOIC . AGOPf•S
�dAf �2pre /moils-,r4r +'l�1 .:7.yr r: c t. d c c Ifi
RIIYRDLt NO FOR WECR NO IJECT AND LUC �ON PRnJ C f DN ACi
/c• a
s k s— << , <
cu Yngg Ot �t- IQ DAY AND oA!L IS) nr rTr
XAMk. A004F55. NIO @, wDRN ,ram. 5 S ,m 7 .'�'r 600b , ". AGE
SOCIAL BFCUM N{NHEN tS � A r TOTM MTF I W>GES
C'ASSIrICAT10N ` r HOURS w MY 'EA, � W! RD
of[YRLOVCC —_— EwdNCD PICA PCEAAn _ --T-- — ,RAw r•
�E HOURS WGRNED EACH DAY
" O 1 Gar.[�If7 D �: I I
/J7i77+lo u � J'"'""� i r Sv v oa' Ss 9f, Go
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RIMM IIMaa/046—EfHIMS V WE IM—PYRCNASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMEMTS _ , .
f� SUS IX N O +�I
' w.+w AND N VAT
AND noun OrvtSN1N (For Coetre I t a Optional Uar,` ction,Porrn WH.3S71u'.')
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OS. OFPIA •.,IfOr.
WhGF AND HOUH gVI510N -
..:ION O vu„ a - i.., L4( 1 ) �.<.�r✓ Wp� � � �r
C.E.f.s�/iI�- �ia.ra-�-(�/.{ i rl�v.,%4_ � � �S� [L/� vV �.' ✓•< .ro
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U.S. DEPARTMENT OF LADDER PAYROLL ln.m Agryuvad
WAGE AND HOUR DWteION NuNAel 9u...0 No��-glov3
(For Contractor's Optional Use;Sae Instruction,Form WH-347 tnst.)
MEME u( PNIINXCTON ON MMONigM�1�0N ..y AUONE"
Ze �Ir Iv1� _r '
vU)? J C✓ i�Y.t-l�lG�� l�i�if
MYNOl, ND 1.wECN NO. . � ~IECT AND LOCATION
/ ��l INU � 1 liq UWRNC1 All
fn IA O) UI DAY XNO O4C
..E. ADogtsa. AND ao alh F Sa SU'M11 7 W � I Sys of cu<vr.m. NEr
SOI:IAI ncumIE RUNNER 'p g WOXS tOTM NATC W.tFfb
a ruxsnewnoN 23 24*252627 28;29� HOUR$ or rAr AA%fO wr. en
wu" P
Of EANEOYEE IY•iu O RJVAY W .nLO EACX DAY EA.NEO ilG �R.II.Yrv� .�. _CI V1Ni.X OI WClIr1M'i 11'.q WFfN
yr f e.n» --r-
16301 186th Ave. S.C.
Renton. WA 98055 )n-2 lournevman
535-50-5733 Pelnter s 7U2 7112 17.24 129.10 9.11 4.90 L52 2.59 ( 17.71 , 111.59
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M. D. MOORE CO.,INC* LE77 (DIF
13652 SE 107th Pl. ""``�7
w P.0.Box 2603
RENTON.WASHINGTON 98056 'S'— ,w ae
Phone 255-6076
6.
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WE ARE SENDING YOU !SAttai;h d Under separate corer ele the 1011"ing items:
Shop drawings ... Prints ❑ Filled ❑ Samples L Specffiallorle
Copy of letter i] Change order t] _
ann Van ■o oapen
..
THESE ARE TRANSMITTED as checked be4m:
rapproval El Approved as submitted ❑ ResubmR_copies for approval
r your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As reoue,ted Cl Returned for corrections ❑ Ratum___corrected prints
O For review vrd comment ❑ — _- --.
❑ FOR BIDS DUE_- 19_0 PRINTS RETURNED AFTER LOAM TO US
REMARKS—
COPY TO_
SIGNED'. _
Feuaw..rr.un rr.x.u....n iw,..nMw.s.M"ror'....".
' CONTRACTOR/SUBCONT TOR `�Y rJ
REPORTING PERIOD
MONTHLY MANPOWER UTILIZATION REPORT U �) Month: ,'uly/Ailml9t Year:'+F
To be submitted to the .ity's Project ` Goals and Timetables as committed
Engineer during the 1st week of following in Contractor's Affirmative
moneh while contract is in progress. Prime i
Contractoe is responsible for obtaining , *d
_..bmittti . SurrcTuactor Reports. or per City's Plan 9.1 t
1'u (atm and laeatt,w „f qWi,a:. i Af aer QW.. Flom: (MM and locatloe of castractw)
'.!tv of -^ntnn
oAOSF
This report is required y Executive Order 11246, Section 203. Fall ure to report can
result in sanctions which include suspension, termination, cancellations or debarment of
1. 9. 1. u. f 5. a.
mine- Total tar
Vork Ncure of Employment (3ee footnote) rity number usber
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FILE TITLE
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