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Home My WebLink AboutSWP271853 (3)^ -�~ ACOHD .��wTlFlCATE OF INSURANCE (ACORD 25S - 03/88) ================================================================================ THIS CEHflFlCA)E IS ISSUED AS H MA7[EH OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON lHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALIEN THE COVERAGE AFFURUED BY THE POLICIES BELOW. NAME AND ADDRESS OF AGENCY: HuM*LE & A5HUC1*|ES INS. �Vz SUUTH 3�u r u Hu ll00 REmiUm, wo vH0b/ NAME AND ADDRESS OF INSURED: RW SCUlT CUmSlHULT1Um lm� REmTON, WA 98055 COMPANIES AFFUNDINU COVERAGE: COMPANY 8: COMPANY C: COMPANY D: COMPANY E: ===== COVERAGES ================================================================ THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS OF LIABILITY COMP TYPE POLICY NUMBER IN THOUSANDS (000) LETTER OF INSURANCE EFFECTIVE/EXPIRATION DATE A 6ENEHAL LIABILITY mpC 02 5b 04 X COMMERCIAL 6ENERAL 0*/01/V0 TO 04/01/vi. LIABILITY CLAIMS MADE x UUCU**EmG£ PRODUCTS UUMP/UWS AM 1 Y,000 x UwmE*S & CVNl*Ac|UHS PKU[EC|1VE PERSONAL & MoVER|lSlNb lNJUKY: S z`oov bHUM uCUU**EN[E: $ l`Von FIRE UAMR6E t;\mY l FlRE): s nV MEDICAL EXPENSE (ANY I PERSON): I tj A AUTOMOBILE LIABILITY NPC 02 55 04 ANY AUTO 04/01/90 TO 04/01/91 CSL: S 1,000 x ALL OWNED AUTOS 81: SCHEDULED AUTOS (EACH PERSON) x HIRED AUTOS X NON -OWNED AUTOS BI: GARAGE LIABILITY (EACH ACCIDENT) PROPERTY DAMAGE: HCUHD CERTIFICATE OF INSURANCE - PAUE �Z ' ================================================================================ LIMITS OF LIABILITY COMP TYPE POLICY NUMBER IN THOUSANDS (000) LETTER OF INSURANCE EFFECTIVE/EXPIRATlUN DATE EH. UCCUR./A68HEGAl£ EXCESS LIABILITY TO OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND *STATUTORY* EMPLOYERS' LIABILITY TO EACH ACCIDENT: DISEASE POLICY LIMIT: DISEASE EACH EMPLOYEE: DESCRIPTION OF LP1Emw|IUNH/LUCM|IUmb/VEHlLx-EH/6PtClAL ITEMS: mU/L: AN RtSHEoS ^rmY c*EEK/cPmvum oAxS *|u*M u*olm^ Q*u./40/, UEH|IF/uA/h MuLEH 1S HHuwm PH HoV/{lumPL lm5U*F0. ===== CANCELLATION ============================================================= SHOULD ANY OF THE A80VE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATIO-N DATE THER01', WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE BB -OW NAMED CERTIFICATE HOLDER, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ===== CERTIFICATE HOLDER ====================================================== Cllv OF RENTUm DATE ISSUED: 03/13/90 PUBLIC WORKS DEPT. 200 MILL AVENUE SO. AUTHORIZED REPRESENTATIVE Pipelayer & Caulker Loaders, Overhead under 6 Yards Shovels, Backhoes3 Yards & Under Dozers, D,9 & Wer, Yo-Yo, Pay Dozer factor, 60 HP & LbJw, Backhoe & Attach Flatbed Truck, Single rear Axle Water Mark Mark over 30M Cal. I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT ALL WORKERS I EMPLOYED ON THIS PUBLIC WORKS PROJECT WERE PAID NO LESS THAN THE PREVAILING WAGE RATE AS DETERMINED BY THE INDUSTRIAL STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUSTRIES. I UNDERSTAND THAT CONTRACTORS WHO VIOLATE PREVAILING WAGE LAWS, I. E. INCORRECT CLASSIFICATION/SCOPE OF WORK OF WORKERS, IM- PROPER PAYMENT OF PREVAILING WAGES, ETC., ARE SUBJECT TO FINES AND/OR DEBARMENT AND WILL BE REQUIRED TO PAY ANY BACK WAGES DUE TO WORKERS. NOTARY; (complete 4 copies and have each notarized ) RECEIVED SEP Affidavit of PREVAILING WAGES PAID Public Works Contract ($2500 and OVER) Contract or BPW No. CAG 041-89 Bid due date ,,........................ Dat... ontract ..................... 6/15/89 6/19/89 8/14/89 3.43' 3.43. 4.21 4_21.::::, 4.21 4.21..;... 4.21 4.21 3.71.' .. 3.71 3_.71 :. 3.71- 3.771.:.: 3.71' Name and address of company completing this form: ?S .................................................................................................................................... Company name R. W. Scott Construction Co. .......................................................................................................... ............................... Address 9840 Carr Road .........................................................................................................................................:: City State ZIP v E:>:: ArrjMJ V ZJ) r)epartment or "Dor ana rrtausmes P CrcE. Count ............................. ;MY COMMISSION EXRES.ON................AuG 29 . 7.................................................... 1 1 Slatisl F9� 00Yi11 affidavit of wages 8-88 "� �5 - .......... ....::.: ......:: #20b - May Creek 9940 - Carr Pced ................... ......................... City 1. CRAFT 2. RATE OF < J.KAIhU?HKLT :4.tSII_MAIhL)NU. iOURLYPAY FRINGE BENEFITS OF WORKERS . .......... .. ... ................. 3.43 ...... -3.4 Pipelqyer a� CaaUaaar ..... ... 3-43 Loaciers, Overload u-6-ar 6 yards ............. 5 18 29.... .................. 4.21 �btor -Patml -Gradara u . ... .. .. ... ... ................. 1. ......................... .Novels, B-xkhoas 3 Yards wd ux'6-- ... .... .... &2 4.21/. .. .... ..... ...... 9 .... .... .............. ............ aDoers, D-9 and UiJar, YD-YO, Pay Dower ... .. .... ........... 4.21/ . ..... ....................... nollers,...Crl. ............. 4.21/ U-actor, 60 HP wd u-.dar, e and aattach.x .Ads:,.(Lp...ta and... 'w. I ampsters (6yds thm 12 yds) ...... 3.71": .................. DA4mtem, *77. .. ......... ....1 99.... ... 1 3- Z�.... 7 Flatted alxk, siqggle rear axle 15 75 3.71 ............ ... LcrAbedznd.- lisavy. dzLy----bmiler:._uldw ... 5a ....... ........ 3.71/ 1. Water Turk n-Lk over 30M _--all .................. ............. ...... .. .17o99I.- ........ . . .. . . ... ............ ....... ... ........ .. ... .......................... . ............ I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT ALL WORKERS I EMPLOY ON THIS PUBLIC WORKS NAMP and addressof ........... company compleflng this form: PROJECT WILL BE PAID NO LESS THAN THE PREVAILING WAGE RATE(S) AS DETERMINED BY THE INDUSTRIAL STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUSTRIES. 1UNDERSTAND ...... ................................. ::company name THAT CONTRACTORS WHO VIOLATE PREVAILING WAGE LAWS, R. W. Scott Ctrlstnrtian. 00. I E. INCORRECT CLASSIFICATION/SCOPE OF WORK OF WORKERS' IMPROPER PAYMENT OF PREVAILING WAGES, ETC., ARE SUB- .. ............. : Address 9340- Carr Pced .... .... JECT TO FINES AND/OR DEBARMENT AND WILL BE REQUIRED TO PAY ANY BACK WAGES DUE.TO WORKERS. City .................... . 'Stadi NA .. ............ 'ZIP 9d055 Leto all 4 copies and h NOTARY; have each no!�q��d ..................... I ................................. .. ..... ..(Foi ........ ... :SUBSCRIBED AND SWORN TO BEFORE ME. :Phone number ................ Registration o. THIS DA7E 6�9 ......... ................................................ . ..... ' 2C6 226 4452 :,l:&8MC*22� NOTARY RY PUBLIC IN AND FOR THE STATE . .................... . ::Title. gnature :OF .......... ...... .......... ........... ...... S IGN TURi ... ... .. .. _ ::.::, L&I u 0 1 0 Y: RESIDING AT w pial:CD AP PRO) D Department of Labor and Industries-_ .......................................................................................................... :MY COMMISSION EXPIRES ON By AUG 9 1, .......... 3.1281.92 ..................................................................................... ....... 14,stal Statist4ian F700-029-111 intent to pay 12-88 . .......... ...... ............. ............ .................. .. ..... ...................................... ........... V v ORIGINAL DATE: REVISION �DATE: / lt439 TO: Accounts Payable FROM: Public Works SUBJECT: Construction Contract CAG i dP41- Project Name:`i ��L�fy�l�l�l-��Ci��h �i�Zl•• 1 i�7� 6.� Prime Contractor:I,c� DATE RECEIVED PRIM CONTRACTOR i SUBCONTRACTORS INTENT TO PAY PREVAILING WAGES DATE RECEIVED AFFIDAVIT OF WAGES PAID w �-�" cc: Project File Form: 2/15/85 R. W. SCOTT CONST. CO. 223-01-RW-SC-OC-229 MU 9840 Carr Road RENTON, WA 98055 Phone 226.4452 TO City of Renton WE ARE SENDING YOU & Attached -1 Under separate cover via_ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LIEUTEQ @)IF MUSEDUMQL DATE 9/6/89 JOB NO. 206 ATTENTION Dave Christensen RE CAG o41-89 __the following items: Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 8/29/89 Approved Affidavit of Prevailing Wages Paid CITY OF RENTON THESE ARE TRANSMITTED as checked below: Lj For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS Engineering Dept. ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints PRINTS RETURNED AFTER LOAN TO US COPY TO PNo000T 24T2 a Inc..G w. Mass 01450 SIGNED: Linda Graber, Bkpr If enclosures are not as noted, kindly notify us at once. klATEI!.ENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE 8/20/89 CONTRACT NUMBER CAG-041-89 Date August 22, 1989 1, Terri Scott Bookkeeper do hereby state: (Name of signatory party) (Title) ( 1) That 1 pay or supervise the payment of the persons employed by R. W. Scott Construction Co. (Contractor or subcontractor) on the May Creek/Canyon Oaks Storm Drain ; that during the payroll period commencing on the :14th day of (Building or work) August 119 89 and ending the 20thday of August 1989 r all persons employed on'said project have been paid the full weekly wages earned, that no rebates have been oi'will be made either directly or in- directly to or on behalf of said R. W. Scott Construction Co. from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible de- ductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Slat. 948.63 Slot. 108, 72 Slat. 967; 76 Slat. 357; 40 U.S.C. 276c), and described below: FICA, Withholding Tax, Medical Aid (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborei or mechanic conform with the work he performed. (3) That any apprentices employed in the -above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such_ recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE_ BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employ- ees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Q - Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (Craft) EXhLANATION REMARKS 17 NAME AND TITLE SIGNATURE Terri Scott, Bkpr. The wilful falsification of any of the above slefementa may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. FOM R ee V / �/ PREVIOUS EDITIONS ARE OBSOLETE. DD I NO R . W . SCOTT CONST . (--*J . CERTIFIED PAYROLL REGISTER DATE 8/22/ 89 TIME 14.46 PAGE 1 ACP 32 PERIOD ENDING 3/20/89 OPER 3 1 -- 1 2 -- - - THIS JOB--��--- TAXES UNION 2 NAME AND ADDRESS FIT TX DED EARNINGS 3 3 SOCIAL SECURITY NO --------- HOURS WORKED THIS JOB -------- T`T' PAY NTX ADJ SICK PAY STATE TX FRNGE: DEDUCTIONS DEDUCTIONS 6 a E=MF' GRFFEU E=:MF' MON TUE WED THU FRI SAT SUN TOTAL HR RATE SUBSTNCE WKLY EARN LOCAL NTX FRNGE CODE AMOUNT NET PAY 7 6 e JOSE I ZAMORA 3.0 3.00 OT 23.460 75.43 17.49 0 i 1 E .00 718.73 10 6 4923 S GRAHAM ST .00 .00 53.98 .00 002 .00 .Of,) 11 12 SEAT+hEs WA '-it3 i. i S Gf'N LABOR . i �Ct 7t � . 3c3 . f_ 0 . 00 . 00 571.83 14 1, `.�34-88- 14b9 15 12 t6 13 14 16 19 15 20 16 21 17 22 TOTAL_ HOURS TOTAL- EARNINGS UNION FRINGES TOTAL.. TOTAL 23 �11-8 -ri irr-� -rr�a� THIS -r�-rnr, THIS — 1�L �.inr��:._- - ..I3k}4T�J--EH�t-.. _.24 NET " i-`43r 2a 20 2 # * JOB TOTALS 3.00 70.38 718�73 146.90 571.83 a 21 a 22 a 23 30 31 24 - -.. - 3 3 25 26 34 3 7 - 3 28 3 9 3 3 30 4 41 32 4 4 33 4 4 34 35 47 38 48 37 - - 49 36 5 31 39 52 40 53 41 54, 53 2 43 57 44 5 59 45 g , 46 81 47 82 63 48 64 49 65 SO 66' 67 51 68 52 69 53 70 71 34 72 55 73 36 74 75 7 7 9840 CARR ROAD R. W. SCOTT CONSTRUCTION CO. General Con[mcro:s — 223-01-RIV SC-OC-229-MU RENTON, WASHINGTON 98055 CERTIFICATION BY GENERAL CONTRACTOR REFERENCE: PAYMENT OF PREVAILING WAGES DATE: August 15, 1989 CAG N0. CAG 041-89 PROJECT: May Creek PHONE 226-4452 THIS IS TO CERTIFY THAT THE PREVAILING WAGES HAVE BEEN PAID TO OUR EMPLOYEES AND OUR SUBCONTRACTORS' EMPLOYEES FOR THE PERIOD ENDING August 15, 1989 IN ACCORDANCE WITH THE INTENTS TO PAY PREVAILING WAGE FILED WITH THE WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES. R. W. SCOTT CONSTRUCTION COMPANY COMPANY NAME SIGN PRESIDENT TITLE STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 8/13/89 CAG-041-89 Date August 15, 1989 11 Terri Scott bookkeeper do hereby state: (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by R. W. Scott Construction Co. (Contractor or subcontractor) on the May Creek/Canyon Oaks storm draiq that during the payroll period commencing on the 7th day of (Building or work) August 19 89 and ending the 13tNay of August 1989 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or'will be made either directly or In- directly to or on behalf of said R. W. Scott Construction Co. from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible de- ductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Sent. 948.63 Seat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: FICA, Withholding Tax, Medical Aid (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employ- ees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID 1N CASH - Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on.the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(6) below. (c) EXCEPTIONS EXCEPTION (Craft) EXOLANATION REMARKS NAME AND TITLE SIGNATURE Terri Scott, Bkpr. The wilful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. FOM R ee V / ✓ r'REVIOUS EDITIONS ARE OBSOLETE. DD 1 NO R . W . SCOTT C:ONST . CO. . . ( ' CERTIFIED PAYROLL REGISTER DATE 8 1 ai 89 TIME: 11.00 PACE I ACP32 PERIOD ENDING 8 / 13/99 OPER 2 1 __--- THIS JOB ---- TAXES UNION 2 2 NAME AND ADDRESS FIT TX DED EARNI 3 ------__,.--..CIF'. _. CRAE.L.DE SL __- 4 _.. T_ ADD TRVL.__PAY_. F IC4A-.--UT-X DF--D- - h11SC I 4 SOCIAL SECURITY NO ----------- HOURS WORKED THIS JOB -------- TY PAY NTX ADJ �, SICK PAY STATE TX FRNGE DEDUCTIONS DE;DUCTI 5 5 EMP GRP FED EXMP r'�ON TUE WED THU FRI SAT SUN TOTAL_ HR RATE SUBSTNC;E WKLY EARN LOCAL NTX FRNGE CODE AMOUNT NET PA � 6 ' JOSE I ZAMORA 4. G 3, 7.00 ST 15.640 60.14 13.65 0 > 1 E .00 616. ?7,1 e 4023 S GRAHAM ST .00 .00 46.32 .00 002 .00 1C1 , 001 .'J. -- - - - - _ua_ --- - 0_0 - - - -_Uu - uu3_ CIO- u - 12 -4121 ,a 981 18 GEN LABOR .00 0 109.48 .00 .00 .00 0 496.6tgl 11 534-08-5469 T5 12 16 13 �7 14 16 1fl 15 20 ,s 21 17 TOTAL HOURS TOTAL_ EARNINGS UNION FRINGES TOTAL. 23 TOTAL2a' 's _TDB__ -_- -THIS_ JOE ,ALL---W R --- IN- - NET DEDUCTION iVE r PAY ,5 20 * JOB TOTALS 7.00 109.48 616.77 120.11 496.66 21 22 23 4 25 6 27 29 381 3 30 31 41 32' 4 4 33 q 35 4 47 36 q '3e 5a, 139 51 .. 52 440 53 41 54 55 42 .j 43 57 44 58 59 45 60 46 a1 47 6 z 48 64 49 65 50 66 67 51 6a 52 - _ 6fl 63 7 a 71 54 72 55 73 56 74, 75 7 7 STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE 8/06/89 CONTRACT NUMBER CAG-041-89 Date 8/09/89 1, Terri Scott _ Bookkeeper do hereby state: (Nnme of signatory party) (Title) ( 1) That I pay or supervise the payment of the persons employed by R. W. Scott Construction Co. (Contractor or subcontractor) on the May Creek/Canyon Oaks storm Drain; that during the payroll period commencing on the 31st• day of (Building or work) July 119 89 and ending the 6th day of August 11989 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or in- directly to or on behalf of said R. W. Scott Construction Co. from the full weekly wages eamed by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible de- ductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Slat. 948.053 Sint 10.3. 72 Star. 967; 76 Slat. 357; 40 U.S.C. 276c), and dr_ncribed below: FICA, Medical Aid, Withholding Tax (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) %IIERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employ- ees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH �- Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS Ex CEP TION (Craft) ExPL AN ATION n EMAR ✓.S NAME AND TITLE lIGN ATU Terri Scott, Bk r. �, _(� The wilful falsification of any of the above Statements may suhiect the contractor or subcontractor to civil or criminal prosecution. See Section 1001 nt Title 16 and Section 231 of Title 31 of the United States Code. FOM R ee PREVIOUS EDITIONS ARE OBSOLETE. DD 1 NO R . W . SCOTT CONST. CD . CERTIFIED PAYROLL REG I ST EF: DATE 8/ G9 /89 TIME 11.39 PAGE i ACP32 PERIOD ENDING 8 /t )6 / 89 OPER 3 • ievis MAY CRK--CI`IYN T)R THIS PAY PERIOD � �-- ---7 2 -.----- THIS JOB ----- TAXES UNION 'z' 3 NAME AND ADDRESS FIT TX DED EARN I NGS 4 _ ?IP - CRAFT DESC - TX ADJ TRVL. FAY FICA NTH: DED MISC FRG IN NET :s SOCIAL. SECURITY NO -----_ ____. HOURS Wi'Rr:::EZ) THIS JOB - ----- - - TY PAY NT X AD' SICK:: PAY STATE TX F FiNGE DEDUCTIONS DEDUCTIONS EMF' GRP FED EXMP MON TUE WED THU F-RI SAT SUN TOTAL_ HR RATE SUBSTNCE Wf;LY EARN LOCAL NTX FRNGE CODE AMOUNT NET PAY 'e 7 - 9 e RAY D HALLENGREN 9.0 5 . (.) 13 . c:ii 1 ST 19.250 CHECK:: NUMBER 12()12 10 9 12513 257TH A'`. E SE 1.5 1.50 OT 28. 8eO 161.94 11.82 00 .00 813.32 WAi ,2 98321 E 0 L J I P OPERA . (:ic:) )i) , i)(:) . t )r i c:)c:13 , i )i) 234.84 14 12 536-56-5()(_).3 .00 293. J 7 (_)!) t_1 (,) ()0 J7e • 49 _. _... - - - 16 13 17 14 to 15 DEAN A HARE; I NGTON 8 . (-) 8.() 9.0 8.0 R . 0 40 , C>C) ST 15.64C) CHECK: NUMBER 12014 zo 13701 Si` 268TH 2.0 2.00 OT 23.46ti - 35.St----2-7-.9?---'-001 00 6772.5c_ 21 17 f:.E NT , WA . (_it_) i[ i 5(7 . 5 i . [i(:) i) 12 . U.) , {_)() 22 1a 98(.)42 GEN LABOR . 00 , c:)i) , 00 , c:i0 003 . i:)0 14)E3 . 29 19 ,...� � .00 .-..---6-72. J2°_.--- - --. ---- ...- .,.. .00 2a 5224 . 2 2s 20 1 2 2 ti t2 �-!y�^is F,1_/� if)NDALL. .3 PTIh`il.DE ...-. --'._ -.. ----$.-(_y--- - ----- --- - --- - B. r- f ST 15. 64(.) ___-. 1t78.-A-1-1fr-:-1 I 0C IE .0() crr 5 ...1 .SC 2 23 1 1 c 12c 1 {';:.ENT V.ANGLEYRD . 0 0 . [ )f i 43.75 . c_)c) (_)(_)2 c ic_1 , (_1() 3 to K:ENT W+; (Ei??) . �it=) . (:)i) . 00 i ii) 0 )3 . i 1i=i 161 . 97 3, zs 98c�1 ?k ►�t- tFsfJfi - - :rty*j 1 c5. 12 - - - - . � �t=)2f7: 26 536-7().-9(_)61 z7 0 28 -. 31 29 MARK:: E SC:HW I EGER 8 . 0 e.00 ST 18. 34(.) CHEC:F`: NUMBER 12(.)26 36 34 1() 1�+1�{ FL �a E 3 .�.o OT 27. 51U 9!3.9J 11.c'J U(_>1 T45.2 3 i0 31 if-iUPURN, ._. - - ._--..----_ _...----. -. __-.�. _.�.. -_ -___.. -. 06 .- --- t_>tf-- ----51J-� ` -------- �t'ltf-- - 002 ,()f) �011 4 41 32 980(.)2 TEAM/LOBOY . 00 .00 . �)(.) . i )0 0� )3 )�) 159. 17 4 13 534-`_",8-Ci3c,6 , (7t) 160.48 . 00 , 00 . t_i0 597.06 4 :.)'TEVE J SCOTT 4.0 4.01 ST 15.640 34T��378 -hI S f- NE-- #P-264 WA 98002 GEN LABOR .1 TEAIII T & T 49 so JOSE I =AM0RA Ef . 0 8.0 S . 0 9 .::) 3.5 S1 4823 S GRAHAM S-F 2 . (.) . 5 .5 1 .5 52 SFATTL.E:-, Wf-� 53 4 , )E.) IS"T 1 A , 4 5, ) 1.00 OT 277.690 ST 151.640 4.50 OT 23.46C ) CHECK; NUMBER 12030 a _ a 4 121.46 9.69 t.)()1 .00 63(). 30 c ) ) 47 . 344 . C)(.) 002E . (.)(_) . 00 , CIO , [1(:) , (:)(:) . Q<) t )r) 3 , Ocy 178 .49. . 00 18 / . 5{ 1 , c_)c-) , c_ 0 .00 L}J 1 .8 1 CHECf--.. NUMBER 1 2k )33 74.84 13.27 (.>C)1 .00 714.79 53.6e Of) 002 12 0 R. W. SCOTT CONST. CO. **** CERTIFIED PAYROLL REGISTER **** DATE 8/09/89 TIME 11.39 PAGE 2 ACP32 PERIOD ENDING 8/06/89 OPER 4 206 MAY IS PAY PERIOD --------�' ---- 2 NAME AND ADDRESS FIT TX DED EARNING ------' -------- TX ADJ TRtfL P#Y^— FICA NTX DED MZSt7-- FRIG '%N� NE 5 ' THIS JOB -------- TY PAY NTX ADJ SICK PAY STATE TX FRNGE DEDUCTIONS DEDUCTION8P' FRI GAT SUN TOTAL HR RATE SUBSTNCE WKLY EARN LOCAL NTX FRNGE CODE AMOUNT NET PAY', / CONTINUED /v| .00 .00 .00 .00 003E .00 141.79 12 --- — �� —' —� — -- � �.00� �� .�� -3�r�-- le 11 17 23 18 19 TOTAL HOURS TOTAL EARNINGS UNION FRINGES TOTAL TOTAL 20 THIS JOB THIS JOB — ALL WORK IN NET DEDUCTION NET PAY 26 27 21 ---- '— 12328 .00 2,099.98 4, 158.75 1 ,023.55 3, 135' o T 3 ' 7 39 319 41 51 32 »/ 62 =. A i GARY MERLINO CONSTRUCTION CO., INC. EMPLOYEE UTILIZATION REPORT JOB CODE 89-09 PAGE 2 9125 LOTH AVE S. ONE WEEK ENDING - 8/05/89 RENTON/PARKING LOT SEATTLE, NA 98108 91-1296882 CONTRACT * - (,46? - - - - - - - - - - - - - - - - - - - - - - - - CONSTRUCTION - - - - --TOTAL - - - - - HOURS-- - - - - - ----- BLACK - - - - . I - - - - ----- ----HISPANIC--- - - - - - - - - ----- ASIAN - - - ----- - - - - - - - -----INDIAN---- - -PERCNT- -*EMPL- -#MINR- TRADE M F M F M F M F M F MIN FEM M F M F LABORER JOURNEYMAN 5.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 2 0 0 0 APPRENTICE .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 ---- 0 --- 0 --- 0 --- 0 --- SUB-TOTAL ------- 5.00 ------- .00 -------------- .00 -- .00 ------------ .00 .00 -------------- .00 .00 -------------- .00 .00 ---- .0 .0 2 0 0 0 OPERATOR JOURNEYMAN .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 0 0 APPRENTICE .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 ---- .0 ---- 0 --- 0 --- 0 --- 0 --- SUB-TOTAL ------- .00 ------- .00 -------------- .00 ------- .00 ------- .00 .00 -------------- .00 .00 -------------- .00 .00 .0 .0 0 0 0 0 TEAMSTER JOURNEYMAN .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 0 0 APPRENTICE .00 .00 .00 .00 .00 ------- .00 .00 -------------- .00 .00 -------------- .00 .0 ---- .0 ---- 0 --- 0 --- 0 --- 0 --- SUB-TOTAL ------- .00 ------- .00 -------------- .00 -------- .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 0 0 CARPENTER JOURNEYMAN .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 0 0 APPRENTICE .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 --- 0 --- 0 --- SUB-TOTAL ------- .00 ------- .00 -------------- .00 ------- .00 ------- .00 .00 -------------- .00 .00 -------------- .00 .00 ---- .0 ---- .0 --- 0 0 0 0 CEMENT JOURNEYMAN 8.00 .00 .00 .00 .00 .00 .00 .00 4.00 .00 50.0 .0 2 0 1 0 MASON APPRENTICE .00 .00 .00 .00 .00 .00 .00 ------- .00 .00 -------------- .00 .0 ---- .0 ---- 0 --- 0 --- 0 --- 0 --- SUB-TOTAL ------- 8.00 ------- .00 -------------- .00 ------- .00 ------- .00 .00 ------- .00 .00 4.00 .00 50.0 .0 2 0 1 0 FOREMAN JOURNEYMAN 3.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 1 0 0 0 APPRENTICE .00 .00 .00 .00 .00 .00 .00 ------- .00 .00 -------------- .00 .0 ---- .0 ---- 0 --- 0 --- 0 --- 0 --- SUB-TOTAL ------- 3.00 ------- .00 -------------- .00 ------- .00 ------- .00 .00 ------- .00 .00 .00 .00 .0 .0 1 0 0 0 *TOTALS JOURNEYMAN 16.00 .00 .00 .00 .00 .00 .00 .00 4.00 .00 25.0 .0 5 0 1 0 APPRENTICE .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .0 .0 0 0 0 0 OTHER .00 .00 .00 .00 ------- .00 ------- .00 .00 -------------- .00 .00 -------------- .00 .0 ---- .0 ---- 0 --- 0 --- 0 --- 0 --- GRAND TOTAL ------- 16.00 ------- .00 -------------- .00 .00 .00 .00 .00 .00 4.00 .00 25.0 .0 5 0 1 0 - r--- ---------------- Signature, Title Date NAillaw LIIYJ, TWO A - ASIAN C - CAUCASIAN R621CH I - AMER, INDIAN N - BLACK 0 - OTHER GARY MERLINO CONSTR, CO, INC, DATE - 8/08/89 S - HISPANIC CERTIFIED PAYROLL REGISTER PAGE - ? JOB - 89-09 RENTON/PARKING LOT PERIOD ENDING DATE - 8/05/89 CONTRACT # - -EMPLOYEE NAME AND ADDRESS.. ,,,,, HOURS WORKED , „ „ ,,,, SUMMARY OF EARNINGS ,,,, ,,,,`TTAXES AND DEDUCTIONS ON ALL JOBS,,,, SOCIAL SECURITY NUMBER THIS ALL FEDERAL LOCAL OTHER UNION AFFILIATION -•----------------------------- DAY --- HOURS ----- TYPE ---- RATE ------ --------- JOB --------- JOBS STATE --------- FICA ADJUST ------------------ NET PAY --------- JIMMY D, WILLIAMS MON 4,00 REG 18,610 16902-OTH AVE E SPANAWAY WA 98387 S,S,# - 447-58-1736 REG HOURS 4,00 40,00 69,91 61,50 UNION AFFILIAT - GEM CEMENT MASON PRE:M HOURS ,50 56,95 NAT/C SEX/M GROSS PAY 74,44 758,36 570,00 WILMER GENDREAU MON 2,00 REG 15,460 3702 S. 138TH SEATTLE WA 98168 S,S,# - 501-74-2510 REG HOURS 2,00 40,00 80,69 56,04 UNION AFFILIAT - LAB LABORER III PRE:M HOURS 2,50 50,80 NAT/C SEX/M GROSS PAY 30,92 676,38 488,85 DOUG BENEDICT MON 3,00 REG 21,250 P.O. BOX 325 CARNATION WA 98014 S,S,# - 538-54-2886 REG HOURS 3,00 40,00 185.71 59 UNION AFFILIAT - FOR FOREMAN PREM HOURS 63,84 NAT/C SEX/M GROSS PAY 63,75 850,00 599,86 RAYMOND MELLOR MON 4,00 REG 18,960 839 SOUTH DIRECTOR SEATTLE WA 98108 S,S,# - 5 5-34-5857 REG HOURS 4,00 40,00 164,05 61,50 UNION AFFILIAT - CEM CEMENT MASON PRE:M HOURS 50 58,02 NAT/I SEX/M GROSS PAY 75,84 772,6: 489,05 DAVID ZIMMERMAN MON 3,00 REG 16,730 A - ASIAN C - CAUCASIAN I - AMER, INDIAN N - BLACK 0 - OTHER S - HISPANIC JOB - 89-09 RENTON/PARKING LOT CONTRACT # - GARY MERLINO CONSTR, CO., INC, CERTIFIED PAYROLL REGISTER R621CH DATE 8/08/89 PAGE - 3 PERIOD ENDING DATE - 8/05/89 -EMPLOYEE NAME AND ADDRESS- ,,,,. HOURS WORKED ,,.,, ,,,, SUMMARY OF EARNINGS ,,,, ...,TAXES AND DEDUCTIONS ON ALL JOBS,,,,. SOCIAL SECURITY NUMBER THIS ALL FEDERAL LOCAL OTHER UNION AFFILIATION ------------------------------- DAY HOURS TYPE RATE JOB JOBS --- ----- ---- ------------------------ STATE --------- FICA ADJUST NET PAY --------------------------- 1107 143RD SW LYNNWOOD WA 98036 S,S,# - 535-54-9688 UNION AFFILIAT - LAB LABORER III NAT/C SEX/M REG HOURS PREM HOURS GROSS PAY -TOTAL HOURS- GROSS PAY .,.,, TOTAL TAXES/ TOTAL THIS JOB THIS JOB ALL JOBS DEDUCTIONS NET PAY" ---------------------------------------------------- 16,00 295,14 3,680.55 1,001.69 2098,86 100 32,00 3,50 50,19 623,19 78,46 46,80 46.81 451,10 U.s. ot:r'AnTMENT OF LAnon Form Appro—i wACr Arlo Notrn OtvISION S-rATEMENT OF COMPLIANCE nv,taeI 13ure.0 No. 44-PIC93 mate August 10, 1989 1. Amy Mitchell _ Bookkeeper do hereby slate: F*--e nt r{Rnalnry p.rly) (title) (1) That I pay or supervise the payment of the persons employed by - Gary Merlino Construction Co. Inc the Renton/Parking Lot (Cont,actef er eubconrrector) that during the payroll period commencing on the_29 day or July . (nvildlne nr werk) 1989 and ending the -day day of AllgllSt 19 89 all persons employed on snid project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Gary Merlino Construction Co., Inc. lComraclor or Itsfrom the full weekly wages earned by any person and that no deductions have conlraa ,.,,� been made either directly or indirectly from the full wages enn,ed by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtillc A), issued by the Secretary of Labor under the Copeland Act, As amended (48 Slat. 948.63 Slat. 108, 72 Slat, 967; 76 R(At. 357; 40 U.S.C. 276c), and described below: FICA, WT & mn (2) That any pa)rolls other vise under this contract required to be submitted for the nbove period ore correct and complete; that the wage rates for Inborersor mecl,nnics contained therein tire not less than tine applicable wage rates contained in any -age detenninntion incorporated into the contract; that the clnssifications set forth therein for each laborer or mechanic con- form with the work Ire performed. (3) l hat any apprenlires employed in U,e above period are duly registered in it bona fide Apprenticeship program registeted with a State apprenticeship agency recopnlzed by the Tlurenu of Apprenticeship and Training, United States Department of Lnbnr, or if no such recognized Agency exists In A State, tire registered with the Bureau of Apprenticeship end Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVI ) PLANS, FUNDS, OR PROGRAMS PX] - In addition to the basic hourly wage rates paid to ench laborer or mechanic listed in the above referenced pay- roll, payments of fringe benefits ns listed In the contract have been or will be made to appropriate programs for the benefit of such employees• except As noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASI1 - F.ach Laborer or meChnllrc listed in the above referenced pnyroll has been paid as indicated on the payroll, 'an amount not less than the sum of lire applicable bnsic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (C) E• XCEP I -IONS EXCEr TION (CRAFT) EXPLANATION nEraARI(! rI.-C ANO TI I sloNATVnE i Amy M. Mitchell Bookkeeper /l - =� - TI.[ wrL FVL FA L3I FICATION OF ANV 7F TIIE AnOVE lTA T[M FN TS MAY SU EJECT Tr. CONTRAC Tort OR SU aCON TRAC TOR TO CIVIL on CnIIAtNAL r•ROSr:CUTIoN SEE SECTION 1001 OF TITLE la ANO SECTION 231 OF TITLE 31 of THE VNITEO STATES Coot STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 7/30/89 CAG-041-89 Date August 1, 1989 I, Terri Scott Bookkeeper do hereby state: (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by R. W. Scott Construction Co. (Contractor or subcontractor) on the May Creek/Canyon Oaks storm drain ; that during the payroll period commencing on the 24th day of (Building or work) July .19 89 and ending the 30thday of July 1989 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or'will be made either directly or in- directly to or on behalf of said R. W. Scott Construction CO. from the full weekly Wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other then permissible de- ductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Slat. 948.63 Slat. 108, 72 Slat. 967; 76 Slat. 357; 40 U.S.C. 276c), and described below: FICA Medical Aid Withholding Tax. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less then the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS - In addition to the basic hourly wage rates paid to each laborer or mechanic listed ih the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employ- ees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH - Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on.the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (Craft) EXISLANATION 1 REMARKS NAME AND TITLE Terri Scott, Bkpr.EV SIGN AT VRE The wilful falsification of any of the above statements may subject the contractor or subcontractor —To civil or criminal prusecution. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. \1\ DDFORM 879 PREVIOUS EDITIONS ARE OBSOLETE. I Nov ae R. W. SCOTT CONST. CO. CERTIFIED PAYROLL_ REGISTER DATE 7/31/89 TIME 14.13 PAGE 1 ACP32 PERIOD ENDING 7/ 30/99 OPEFi 2 u 206 MAY CRK-CNYN DR ------ THIS PAY PERItiD--------- 2 -- THIS JOB ---- TAXES UNION NAME AND ADDRESS FIT TX DED EARNINGS 4 ZIP CRAFT DESC ---- TX ADJ TRVL FAY FICA NTX DED MISC FRG IN NET5 s SOCIAL SECURITY NO ------------ HOURS WORKED THIS JOB --------- TY PAY NTX ADJ SICK PAY STATE TX FRNGE DEDUCTIONS DEDUCTION 6 EMP GRP FED EXMF MON TUE WED THU FRI SAT SUN TOTAL. HR MATE SUBSTNCE WKLY EARN LOCAL NTX FRNGE CODE AMOUNT NET PAY 71 7 rs RAY D HALL_ENGREN 8 .0 8.0 6.5 22.50 ST 19.250 139.03 11.81 001E .00 731.50 ) 9 12513 257TH AVE SE .00 .00 54.94 .00 02 .00 .00 10 BUCKLEY, WA .00 .00 .00 .00 003 ,0 ► 205.78 ,,. 11 98321 EQUIP OPERA .00 433.12 .00 00 .00 525.72 141 12 5:36-56-5003 15 t5 13 1 17 1e' 16 15 DEAN A HARK I NGTON 8.0 8.0 8. 0 8. 0 32.00 ST 15.640 CHECK NUMBER 11984 A- 213701 SE 268TH -- .9 - - 1 .5= . 5�4 .00 OT 23.460 92.85 13.59 001 .0 i 719.44-t::E_h1T , WA . C)r) . c )c=) 5 4 . C)3 ,c=)r) C)C). C)C) .c )0 2 la 98042 GEN LABOR .00 .00 .00 i .00 003 .00 160.47231 ��3'3-62-817'7 -- -- . 00 ►94.32 .00 . GC) . C)C) 5`-:8. 9 24 l la ' 2s 20 1. 26 21 127I 2RANDAL_L. J PATNODE a, C) 8.00 ST 15.640 CHECK NUMBER 11990 11020 KENT KANGI._EYRD .5 .50 OT 23.460 136.57 12.11 001 .00 684.25 23 - 241 KEN WA (B77) . C)C) .00 5+ 1 . 39 . c 0 +. 02 .00 . 00 3, 28091 GEN LABOR .00 .00 0 .00 .00 0 003 .00 0 200.07. 3 A 536-70-9061 .00 136.85 .00 .00 .00 484. 18 34 09 7 3 29 29 MARk''. E SCHW:IEGER 8.0 8. 0 ST 18.240 82.61 11.25 001E .00 669.663 .._ _ 34210 141 ST PL S E . � 0 .00 51.79 .00 )i_) 002 .00 0 003 30 31 AUBURN, WA - - - . C )C) .00 . 00 . C ,Cl i_ 0 3 [ 0 145 . 6541 98002 TEAM/SOLO .00 145.92 .00 .00 .00 544.01 3: 534-58 -t )35 6 43) 33 2 -- - - - 34 35 C) RODNEY A SCOTT 1 0 1.00 ST 18.24158.52 11.54 001E .00 762.651 3 724 2ND AVE S #4 - _ T- .00 .00 57.26 .00 •' 37 KE.NT , WA .00 .00 .00 .00 003 .00 227.34 38 98032 TEAM/SOLO .00 18.24 .00 . 00 .00 535.31 39 33-84-'80 )7 - 40 5 41 54 SS 42 r 8.0 2 - r- - 56 43 JCiSE I :'AMOF:A 8.0 8.0 r_t . C) ; 1� . c_)c) �, 1" 15.640 Ci-�ECIC hJl1�'lL•I�fi 12002, 57 4823 S GRAHAM S'•I- 1.0 .5 1.0 2.50 OT 23.460 '70.26 13.16 C 01 .00 0 %4 .25 s 44 SEATTL.E , WA .00 .00 )0 51.38 .00 002 .00 .00 45 99119 GEN LABOR .00 .00 .00 .00 003 .00 134 . eO ab 8 47 ). 63 48 64 49 65 SO N a�l 51 32 TOTAL_ HOURS TOTAL EARNINGS UNION FRINGES TOTAL_ TOTAL R. W. SCOTT• CONST. CO. CERTIFIED PAYROLL REGISTER DATE 7/31/89 TIME 14.13 PAGE 2 ACF32 PERIOD ENDING 7/30/99 OPER 3 is 1 CLTp------ ' - MM T UMN—UM T K UM-- —•••-'------ I n 1 ZI r n T r- Gn 1 vL — — — — — — — — — ---- THIS JOB ---- TAXES UNION NAME AND ADDRESS FIT TX DED EARNINGR� — ZIP CRAFT DESC SOCIAL SECURITY NO ---------- - — TX ADJ HOURS WORKED THIS JOB -------- TY PAY NTX AD.J TRVL SICK PAY PAY FICA STATE NTX DED TX FRNGE MISC • DEDUCTIONS FRG IN NEV* DEDUCTIO$ � e 3 EMP GRP FED EXMP MON TUE WED THU FRI SAT SUN TOTAL HP RATE SUBSTNCE WKLY EARN LOCAL NTX FRNGE CODE: AMOUNT NET PAY 71 6 THIS JOB THIS JOB — ALL WORK IN NET DEDUCTION NET PAY 7 a >F JOB TOTALS 110.OU-----��Sd3-�.`'.,S 4,271.'.7`� --T,074.11 3.197.64 10 II 15 12 /6 13 14 18 19 15 2O re 17 22 23 18 24 19 25 20 2 21 2 22 23 31 24 3 25 3 26 3 35 27 36 26 3 29 3 30 4 31 41 32 - 42, 33 4 4 35 4 47 36 48 37 4 3B 51 39 52 4t 54 SS 42 515 43 57 44 58 59 45 60 46 61 47 62 48 64 49 65 SO 66 67 51 68 52 69 70 71 153 54 72 55 - J737 r • • t -ii j`. s •i U. S. DEPARTMENT OF LABOR MONTHLY EMPLOYMENT 1.cotrsweo.ws.is^as.owsw 1t cNwws«rco. .,..lvl..crt.tee 1 Employment Standards Administration. OFCC! UTILIZATION REPORT j MINORITY: FROM: The rowers at ateewd tnr .—..—* 0.0- 11240—ft to Iaat taw —it M 40.1,K{r [M.f, i. (VLO�t As 1.0. NQ. swsttd• lames) wd w tarawbo .w whela M rl sere was the srw wwr wry �e daetwd wr1�tW I« FEMALE' TO. 91 1038390 terfhf Gvwwwtwm swatracis el eswo d onow rstrw oaMIML FEDERAL NAME AND LOCATION OF CONTRACTOR FUNDING City of Renton R. W. Scott Construction Co. AGENCY 220 Mill Avenue S. CAC-041-89 9840 Carr Road Renton, WA 98055 May Creek Renton, WA 98055 i 6. WORK HOURS OF EMPLOYMENT (Federal dl Non -Federal) S. 10' sa 64• 6a 7. 1L � TOTAL TOTAL NUMBER OF CONSTRUCTION TOTAL ALL BLACK ASIAN OR AMERICAN EMPLOYEES (Net of HISPANIC PACIFIC INDIAN MINORITY FEMALE OR NUMBER OF EMPLOYEES OYEES MINORITY TRADE Classifications BY TRADE Hlsponte Orrin) tSLANOERf ALASKAN PERCENTAGE PERCENTAGE EMPLOYEES NATIVE M Is M F M F M F M Is M i M F Jpttrnay MIO/kN APPRENTICE Flagger TRAINEE SUB -TOTAL - Jowney ylO.kw ��/ ' Equipment APPRENTICE Operator TRAINEE SUB -TOTAL 1 G journey ..ors.. APPRENTICE Teamster TRAINEE SUB -TOTAL Jowney workw /Ll.�/ / APPRENTICE Laborer TRAINEE SUB -TOTAL }ewrtey wor kw - APPRENTICE TRAINEE SUB -TOTAL , TOTALMURNEY WORKERS TOTAL APPRENTICES�en� TOTAL TRAINEES / GRAND TOTAL SZ; COMPANY OFFICIAL'S SIGN A RE AND TITLE 12 TELEPHONE NUMBER !Include wee cove! M DATE SIGNED PAGE Rk-4, Bkpr. 206-226-4452 i;j 01106 APPROVAL NO. AXA I -- — J E J FORM C& it1��' �/1� SEP 1 j°89 �� CITY OF RENTON Engineering Dept. STATEVIE.RT 0 COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTR ACT NUMBER 7/23/89 ICAG 041-89 Date 89 I Terri Scott _ _ Bookkeeper do hereby state: {lYnrnc n/ ,a ignnlory party) (Title) ( 1) That I pay or supervise the paN,ment of the persons employed by R. W. Scott Construction Co. (Contractor or subcontractor) on the May Creek/Canyon Oaks Storm Drain ; that during the payroll period commencing on the 17th day of (nuilding of work) July 19 89 and ending the 23rdday of July 19 89 all persons employed on said project have been paid the full weekly 'wages earned, that no rebates have been or will be made either directly or in- directly to or on belrnlf of said R. W. Scott Construction Co. from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible de- ductions as defined in Rcgulntions, Part 3 (29 CFR Subtitle A), issued by the Secretary of [labor under the Copeland Act, as amended (48 Sint. 948.63 Sint. 108, 72 Stat. 967; 76 Slat. 357; 40 U.S.C. 276c), and described below: FICA, Medicai Aid, Withholding.Tax (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exir.ts in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (n) WHERE. FRINGE_ 1ENEI-ITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS Ln- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employ- ees, except as noted in Section 4(c) below. (b) WHERE. FRINGE BENEFITS ARE PAID IN CASH U- Each lalyrrer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS Ex CEPTION (Crattl EXPLANATION REMARKS NAME AND TITLE Terri Scitt� Bkpr• _� SIGNATURE_ j' J The rvillul lalsilicntion of any of (lie above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. DD1 FORM ��%" r'REVIOUS EDITIONS ARE OBSOLETE_. Nov ee ` �J r L R. W. SC(3TT CONST. CO. CERTIFIED PAYROLL REGISTER DATE 7/26/29 TIME 9.57 PAPE I ACP32 PERIOD ENDING 7/22/89 OPER 3 r1R ---- THIS JOB TAXES UNION 2, NAME AND ADDRESS FIT TX DED EARNINGS, 1I3 - ZIP CRAFT DE SC:: TX ADJ TRVL PAY FICA NTX DED misc FRG IN NET 14 SOCIAL SECURITY NO --------- HOURS WORKED THIS JOB --- ---- -- TY PAY NTX ADj SICK PAY STATE TX FRNGE DEDUCTIONS DEDUCTIONS, 5 EMP GRP FED EXMP MON TUE WED THU FRI SAT SUN TOTAL HR RATE SUBSTNCE WKLY EARN LOCAL NTX FRNGE CODE AMOUNT NET PAY 7 E Vs C dif 1.5 1.50 ST 18.240 108.25 11.78 001E .00 583.09 lei 343B I ST NE #P-204 .00 .00 43.79 .00 002 .00 . 00 AUBURN, WA .00 . 00 . 00 . 00 o03 .00 163.82 98002 TEAM/SOLO .00 27.36 .00 .0(") .00 419.27 533-84-8444 14 I 15 )6-- 7 TOTAL HOURS TOTAL EARNINGS UNION FRINGES TOTAL TOTAL 8! TUT S -JjZLEL---=- --CALL.... klt]Eik;- T IN] 1-0111 ------ I191 I zu * i ** JOB TOTALS 1.50 27.36 593.09 163.82 419.27 2LI 22 23 24 25 26 32 37 38 !39 4c Iaz sr, 43 7 44 ,48 40 50: tA 54 56, Vyy� �r i MONr"LY EMPLOYMENT 1 r'"D "" M-" OrlGuww�w9 ra. •rwlali'"-ee . S. DEPARTMENT OF LABOR U7 � Employment Standards Adminittratlon, OFCCP UTILIZATION REPORT MINORITY: FROM: r hr f"w A edIry 1—wi-- O,Gff I I2• .wMr� la fwAf1 Vn r.Yll M pantra[ff Mw4l j, IVLOyr.hr• I.D. MO. fNYI or,��• I.f,n.,ar� �. f.r+a+we.d .w rwN� r Iw Mrt rr nM awwrrkkrM wl.y M Iedrwl ...kl• 1« 91 1038390 FEMALE: TO: / l fwthw Goywww.wlt aa.rlraers o/ FEDERAL NAME AND LOCATION OF CONTRACTOR FUNDING City of Renton R. W. Scott Construction Co. AGENCY 220 Mill Avenue S. CAG-041-89 9840 Carr Road Renton, WA 98055 May Creek Renton, WA 98055 S S. WORK HOURS OF EMPLOYMENT (Federal & Non -Federal) �' to 6IL br- 69L be. 7. 1L TOTAL ALL BLACK ASIAN OR AMERICAN TOTAL NUMBER OF TOTAL NUMBER OF CONSTRUCTIDN INDIAN EMPLOYEES (Met e/ HISPANIC PACIFIC OR MINORITY FEMALE EMPLOYEES MINORITY EM►LOYEES TRADE Clani iceuora BY TRADE H.noew.e Onrn) ISLANDERS ALASKAN ►ERCENTAGE PERCENTAGE NATIVE M P Y P Y F M P Y P M P Y P Jo�rrMy wlOrkel � APPRENTICE Flagger TRAINEE SUB -TOTAL - Jowney ~kw 4 L 1 . Equipment APPRENTICE Operator TRAINEE SUB -TOTAL , /1• Jo„rney w 'kw C APPRENTICE m Teaster TRAINEE sue -TOTAL , Jow..ey worker 1 APPRENTICE TRAINEE Laborer SUB -TOTAL 9j J~." W kw -- APPRENTICE TRAINEE SUB -TOTAL TOTALJOURNEY WORKERS TOTAL APPRENTICES TOTAL TRAINEES 3100 GRAND TOTAL d `I 11. COMPANY OFFIMAL•S SIGNATURE AMDD TITLE 12. TELEPHONE NUMBER Ilnoude was weal 12. DATE SIGNED PAGE G) l L'� I 1 or L L J C 'u BkPr. 206-226-4452 U�7 OMB APPROVAL NO. "-R 1396 FORM =."7 lRw. SIM CITY OF RENTON Engineering Dept.