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AGENDA BILL SCHEDULE AGENDA BILL TITLE PREPARED BY: 1:1&ky\ �L_ i9-40_r� Extension: 7 a-2 DEADLINE/DATE ACTION GREGG'S SIGNATURE TRANSMIT TO CLERK VIA Electronic Agenda Bill Process COUNCIL MEETING DATE Referred to Committee COMMITTEE MEETING DATE (e-mail Committee Report to Teresa who will final it and send it up to Julia) COMMITTEE Time: Place: COUNCIL MEETING REPORTED OUT Ya USAN17ksc \Forms\AB-Schedule\tp CITY OF RENTON COUNCIL AGENDA BILI Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems Division/ April 23, 2012 Wastewater Utility Agenda Status Staff Contact...... John Hobson, x7279 Consent .............. X Public Hearing.. Subject: Final Pay Estimate CAG 10-142 Correspondence.. Westview Lift Station Upgrades Ordinance ............. Contractor: First National Insurance Company of Resolution............ America Old Business........ New Business....... Exhibits: Issue Paper Study Sessions...... Final Pay Estimate Information......... Notice of Completion of Public Works Contract Recommended Action: Approvals: Council Concur Legal Dept......... Finance Dept...... X Other ............... Fiscal Impact: Expenditure Required... $12,987.44 (Final Pay Est.) Transfer/Amendment....... Amount Budgeted....... $20,000 Revenue Generated......... Total Project Budget $150,000 (2011) City Share Total Project.. $75,000 (2012 Carry -forward) SUMMARY OF ACTION: The project was awarded on December 13, 2010. Construction began on April 8, 2011, and was completed on March 26, 2012. The original contract amount was $101,835.00 and the final amount is $135,287.50, an increase of $33,452.50 or 33 percent. The increase in cost was due to premature failure of the existing lift station pumps which required additional bypass pumping, excessive groundwater requiring grouting of the wetwell and an unknown buried, large concrete block which had to be removed prior to installation of the pump cable conduits. The amount budgeted in 2011 for the project was $150,000, of which $75,000 was included in the approved 2012 carry -forward ordinance. The total project costs will slightly exceed the $75,000 by approximately $3,500. However, there are sufficient funds within the Wastewater 426 Capital Improvement Program Fund to cover this slight exceedance. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all -----liens-filed.. — -- -- - - - - - - - H:\File Sys\WWP - Waste Water\WWP-27-3536 Westview Lift Station Upgrades\PAY ESTIMATES\Agenda Bill Final Pay Westview Lin Station Upgrades.doc\JDHah PUBLIC WORKS DEPARTMENT c;cyof M E M O R A N D U M DATE: April 10, 2012 TO: Rich Zwicker, Council President Members of the Renton City Council VIA: Denis Law, Mayor // FROM: Gregg Zimmermah`P�Administrator STAFF CONTACT: John Hobson, Wastewater Utility, x7279 SUBJECT: Final Pay Estimate CAG-10-142, Westview Lift Station Upgrades, Contractor: First National Insurance Company of America irri ir. Should the City accept the project and approve the final pay estimate for CAG-10-042 with First National Insurance Company of America for the Westview Lift Station Upgrades project? RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all liens filed. BACKGROUND SUMMARY: Council awarded the Westview Lift Station Upgrades contract to Advanced Construction, Inc. on December 13, 2010. Due to weather constraints and equipment ordering lead time, their first working day was April 8, 2011. The City received a letter from Advanced Construction, Inc. dated June 30, 2011, notifying the City that the contractor was in default under the terms of the contract due to financial hardships. The contractor made notification that any further correspondence should be directed to their surety, First National Insurance Company of America. The City of Renton sent a letter via certified mail, dated July 14, 2011, informing the -----contractor's surety -that we -were terminating its -contract -with -the -contractor -(Advanced ---- Construction, Inc.). The City's letter also stated that the City was making a claim under the performance bond issued by the surety. Mr. Zwicker, Council President Page 2 of 2 April 10, 2012 On September 2, 2011, a takeover agreement was executed between the City and First National Insurance Company of America that formally transferred the construction contract (CAG-10-142) to the surety. In September 2011, the surety company hired Omega Contractors, Inc. to complete the work associated with the construction contract. Omega Contractors, Inc. commenced construction operations in mid -October and completed the work on March 26, 2012. The original contract amount was $101,835.00 and the final contract amount is $135,287.50, an increase of $33,452.50. The additional costs to complete the construction were a combination of the following unforeseen conditions: • Premature failure of the existing Westview lift station pumps that required additional bypass pumping. • Unexpected groundwater intrusion that required extensive grouting to allow for wetwell coating application to be completed and for the readjustment of the valve vault. • The removal of an unknown, large block of concrete adjacent to the wetwell to allow installation of the pump cable conduits. The amount budgeted in 2011 for the project was $150,000, of which $75,000 was included in the approved 2012 carry -forward ordinance. The total project costs will slightly exceed the $75,000 by approximately $3,500. However, there are sufficient funds within the Wastewater 426 Capital Improvement Program Fund to cover this slight exceedance. CONCLUSION: The City should approve the final pay estimate for the contract, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all liens filed. cc: Lys Hornsby, Utility Systems Director Dave Christensen, Wastewater Utility Supervisor HA,rniie5ys'%vv"vvP- VJasteWater\\.�.v.�1P-"'I-3536Westview LitStation UP;zrad 2s\ AVESTITES\,ssuePaper for Finn of Westview Lift Station Upgrades.doc/JDHah TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: First National Insurance Company of America CONTRACT NO. CAG-10-142 PO# 18/0001780 ESTIMATE NO. 4 (Final) PROJECT: Westview Lift Station Upgrades .1. CONTRACTOR EARNINGS THIS ESTIMATE $11,860.68 2. SALES TAX @ 9.50% $1,126.76 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $12,987.44 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $106,105.07 5. EARNINGS DUE CONTRACTOR THIS ESTIMATE $11,267.65 6. SUBTOTAL - CONTRACTOR PAYMENTS $117,372.72 7. RETAINAGE ON PREVIOUS EARNINGS $5,584.48 8. " RETAINAGE ON EARNINGS THIS ESTIMATE $593.03 9. SUBTOTAL - RETAINAGE $6,177.51 10. SALES TAX PREVIOUSLY PAID $10,610.51 11. SALES TAX DUE THIS ESTIMATE $1,126.76 12. SUBTOTAL - SALES TAX $11,737.27 (95% x LINE 1) " (RETAINAGE: 5%) GRAND TOTAL: $135,287.50 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 426.465479.018.595.35.63.000/u45479.f010 $12,394.41 # 4 (Final) RETAINED AMOUNT (Line 8): ACCOUNT # 426.465479.018.595.35.63.000/u45479.f010 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID LAIM Signed: $593.03 # 4 (Final) TOTAL THIS ESTIMATE $12,394.41 $593.03 $12,987.44 Printed On: 03/26/2012 City of Renton Public Works Department Page 1 Printed On: 03/26/2012 City of Renton Public Works Department Page'1 Project: Westview Lift Station Upgrades Contractor: First National Insurance Company of America Item Description Contract Number: CAG-30-142 Pay Estimate 4 (Final) Closing Date: 03/26/2012 Unit Est. Unit Previous Previous This Quantity Price Quantity Amount Quantity 001. Trench and Excavation Safety Systems Lump Sum 1 $2,000.00 1.00 $2,000.00 002. Westview Lift Station Upgrades Lump Sum 1 $91,000.00 1.00 $91,000.00 003. C.O. #1 Hatch Replacement at East Renton LS Lump Sum 1 $3,725.00 1.00 $3,72S.00 004. C.O. #2 Non -Sparking Fittings for Pumps Lump Sum 1 $1,220.69 1.00 $1,220.69 005. C.O. #2 Additional Bypass Pump and Pumping Lump Sum 1 $8,919.76 1.00 $8,919.76 006. C.O. #2 Urethane Grout Injection Lump Sum 1 $4,824.10 1.00 $4,824.10 007. C.O. #3 Remove and Reset Valve Vault Lump Sum 1 $2,541.30 0.00 $0.00 1.00 008. C.O. #3 Additional Crushed Rock for Valve Vault Lump Sum 1 $872.41 0.00 $0.00 1.00 009, C.O. #3 Grout Voids around Valve Vault Lump Sum 1 $182.56 0.00 $0,00 1.00 010. C.O. #3 Replace Upper Section of Wetwell Lump Sum 1 $1,139.04 0.00 $0.00 1.00 011. C.O. #3 Remove Buried Concrete Mass Lump Sum 1 $1,659.76 0.00 $0.00 1.00 012. C.O. #3 Change force main material from PVC to DI Lump Sum 1 $1,426103 0.00 $0.00 1.00 013. C.O. #3 2-5" Conduits to Replace "Fibercrete" cable trench Lump Sum 1 $661.87 0.00 $0.00 1.00 014. C.O. #3 Provide two start capcitors Lump Sum 1 $191.58 0.00 $0.00 1.00 015. C.O. #3 Additional Pit Run Lump Sum 1 $1,875.50 0.00 $0.00 1.00 016. C.O. #3 Saw Cut and Remove Additional Asphalt Lump Sum 1 $148.16 0.00 $0.00 1.00 Oil. C.O. #3 Provide and Install Additional Intrinsically Safe Barrier Lump Sum 1 $1,162.47 0.00 $0.00 1.00 Subtotal 9.5% Sales Tax TT Total This Tota $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2,541.30 $877.41 $182.56 $1,139.04 $1,659.76 $1,426.03 $661.87 $191.58 $1,875.50 $148.16 $1,162.47 I Total ty Amount 1.00 $2,000.00 1.00 $91,000.00 1.00 $3,725.00 1.00 $1,220.69 1.00 $8,919.76 1.00 $4,824.10 1.00 $2,541.30 1.00 $872.41 1.00 $182.56 1.00 $1,139.04 1.00 $1,659.76 1.00 $1,426.03 1.00 $661.87 1.00 $191.58 1.00 $1,875.50 too $148.16 1.00 $1,162.47 $111,689.55 $11,860.68 $123,550.23 $10,610.51 $1,126.76 $11,737.27 $122,300.06 $12,987.44 $135,287.50 31Z,IP11 L 9� 2 h1f 6 STA7'g yis f NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Contractor's UBI Number: 602028753 Date: 04/05/2012 r . Name &-Address: of Public Agency City of Renton 1055 S Grady Way Renton WA 98057 UBI Number: 177000094 Department Use. :Only Assigned to: Date Assigned: Notice is hereby given relative to the completion of contract or protect described below Project Name Contract Number Job Order Contracting Westview Lift Station Upgrades I CAG-10-142 ❑ Yes ❑ No Description of Work Done/Include Jobsite Address(es) Rehabilitate and Upgrade the existing Westview Lift Station - 1149 Monterey Ave NE Federally funded road transportation project? ❑ Yes 0 No Contractor's Name Telephone Number First National Insurance Company of America 206-473-5929 Contractor Address 1001 Fourth Avenue, Suite 1300, Seattle WA 98154 If Retainage is Bonded, List Surety's Name (or attach a copy) Surety Agent's Address Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted 12/ 13/2010 104/08/2011 03/26/2012 104/16/2012 Contract Amount Additions ( +) Reductions (-) Sub -Total Amount of Sales Tax Paid at 9,500% (If various rates apply, please send a breakdown) TOTAL Please List all Subcontractors Below: $ 93,000.00 $ 30,550.23 Liquidated Damages $ $ Amount Disbursed $ 129,109.99 $ 123,550.23 Amount Retained $ 6,177.51 $ 11,737.27 $ 1359287.50 TOTAL $ 135,287.50 NOTE: These two totals must be equal Subcontractor's Name: UBI Number: Affidavit ID (if known) Omega Contractors, Inc 600364333 379878 , F2 15-038-000 08-2011 REV 31 0020c (08/25/11) Continued on page 2 Please List all Subcontractors Below: Subcontractor's Name: I UBI Number: I Affidavit ID (if known) C-omments . Advanced Construction, Inc. (UBI #602273113) was awarded the contract on Dec. 13, 2010. They defaulted on the contract on June 30, 2011. Their surety, First Nation Insurance Company of America, assumed control of the contract on September 2, 2011. They hired Omega Contractors, Inc. in September 2011 to complete the construction. Omega Contractors, Inc. began construction in October 2011 and completed construction on Nlarch 26, 2012. Contact Name: Natalie Wissbrod Title: Accountmg Assistant nI)c A'20 <010 Ernatf Address: nwissnrodtwrentonwa.gov ruuue lNurrruer: Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form to all three agencies below. For a faster response, please submit by e-mail. Washington State Department of Revenue - Public Works Section Washington State Department -of- Labor and Industries Contract Release Washington State --Employment Security Department 7=77Specialized Collections Unit PO Box 47474 PO Box 44274 PO Box 9046 Olympia WA 98504-7474 Olympia, WA 98504-4272 Olympia WA 98507-9046 (360)725-7588 (360)902-4754 (360) 902-9780 FAX (360) 664-4159 FAX (360) 902-6897 Fax (360) 902-9287 PWC@dor.wa.gov ContractRelease@lni.wa.gov publicworks@esd.wa.gov For tax assistance or to request this document in an alternate format, visit http://dor.wa.Qov or call 1-800-647-7706. Teletype (TTY) users may call (360) 705-6718. F215-038-000 08-2011 REV 31 0020e (8/25/11) Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems Division/ April 23, 2012 Wastewater Utility Staff Contact...... John Hobson, x7279 Agenda Status Consent .............. X Subject: Public Hearing.. C F UN RCIE Final Pay Estimate CAG 10-142 Correspondence . DATE: Westview Lift Station Upgrades Ordinance............ ME 'NITII Contractor: First National Insurance Company of Resolution......... America Old Business...... Exhibits: New Business..... Issue Paper Study Sessions..... Final Pay Estimate Information......... Notice of Completion of Public Works Contract Recommended Action: Approvals: Council Concur Legal Dept......... Finance Dept...... X Other ............... Fiscal Impact: Expenditure Required... $12,987.44 (Final Pay Est.) Transfer/Amendment....... Amount Budgeted....... $20,000 Revenue Generated......... Total Project Budget $150,000 (2011) City Share Total Project.. $75,000 (2012 Carry -forward) SUMMARY OF ACTION: The project was awarded on December 13, 2010. Construction began on April 8, 2011, and was completed on March 26, 2012. The original contract amount was $101,835.00 and the final amount is $135,287.50, an increase of $33,452.50 or 33 percent. The increase in cost was due to premature failure of the existing lift station pumps which required additional bypass pumping, excessive groundwater requiring grouting of the wetwell and an unknown buried, large concrete block which had to be removed prior to installation of the pump cable conduits. The amount budgeted in 2011 for the project was $150,000, of which $75,000 was included in the approved 2012 carry -forward ordinance. The total project costs will slightly exceed the $75,000 by approximately $3,500. However, there are sufficient funds within the Wastewater 426 Capital Improvement Program Fund to cover this slight exceedance. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all liens filed. -/y 1 H:\File Sys\WWP - WasteWater\WWP-27-3536 Westview Lift Station Upgrades\PAY ESTIMATES\Agenda Bill Final Pay Westview Lift Station Upgrades.doc\JDHah PUBLIC WORKS DEPARTMENT Cityor M E M O R A N D U M DATE: April 10, 2012 DME:, lv ME z I Il TO: Rich Zwicker, Council President Members of the Renton City Council VIA: Denis Law, Mayor FROM: Gregg Zimmerman, PW Administrator STAFF CONTACT: John Hobson, Wastewater Utility, x7279 SUBJECT: Final Pay Estimate CAG-10-142, Westview Lift Station Upgrades, Contractor: First National Insurance Company of America ISSUE: Should the City accept the project and approve the final pay estimate for CAG-10-042 with First National Insurance Company of America for the Westview Lift Station Upgrades project? RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all liens filed. BACKGROUND SUMMARY: Council awarded the Westview Lift Station Upgrades contract to Advanced Construction, Inc. on December 13, 2010. Due to weather constraints and equipment ordering lead time, their first working day was April 8, 2011. The City received a letter from Advanced Construction, Inc. dated June 30, 2011, notifying the City that the contractor was in default under the terms of the contract due to financial hardships. The contractor made notification that any further correspondence should be directed to their surety, First National Insurance Company of America. The City of Renton sent a letter via certified mail, dated July 14, 2011, informing the contractor's surety that we were terminating its contract with the contractor (Advanced Construction, Inc.). The City's letter also stated that the City was making a claim under the performance bond issued by the surety. `/� N Mr. Zwicker, Council President Page 2 of 2 April 10, 2012 On September 2, 2011, a takeover agreement was executed between the City and First National Insurance Company of America that formally transferred the construction contract (CAG-10-142) to the surety. In September 2011, the surety company hired Omega Contractors, Inc. to complete the work associated with the construction contract. Omega Contractors, Inc. commenced construction operations in mid -October and completed the work on March 26, 2012. The original contract amount was $101,835.00 and the final contract amount is $135,287.50, an increase of $33,452.50. The additional costs to complete the construction were a combination of the following unforeseen conditions: • Premature failure of the existing Westview lift station pumps that required additional bypass pumping. • Unexpected groundwater intrusion that required extensive grouting to allow for wetwell coating application to be completed and for the readjustment of the valve vault. • The removal of an unknown, large block of concrete adjacent to the wetwell to allow installation of the pump cable conduits. The amount budgeted in 2011 for the project was $150,000, of which $75,000 was included in the approved 2012 carry -forward ordinance. The total project costs will slightly exceed the $75,000 by approximately $3,500. However, there are sufficient funds within the Wastewater 426 Capital Improvement Program Fund to cover this slight exceedance. CONCLUSION: The City should approve the final pay estimate for the contract, in the amount of $12,987.44, and release the retainage after 60 days, subject to the receipt of all required authorizations and satisfaction of all liens filed. cc: Lys Hornsby, Utility Systems Director Dave Christensen, Wastewater Utility Supervisor H:\File Sys\WWP - WasteWater\WWP-27-3536 Westview Lift Station Upgrades\PAY ESTIMATES\Issue Paper for Final of Westview Lift Station Upgrades.doc/1DHah r�Washington State r,q� wM ui Department of Revenue evenue PO Box 47474 Olympia, WA 98504-7474 602 028 753 Certificate of Payment of State Excise Taxes by Public Works Contractor FIRST NATIONAL INSURANCE CO OF AMERICA ATTN: JEFF OLSON PO BOX 34670 SEATTLE WA 98124 1670 CITY OF RENTON NATALIE WISSBROD 1055 S GRADY WAY RENTON WA 98057 WESTERN REGION SURETY AUG 0 6 2012 03 We hereby certify that taxes, increases and penalties_ due or to become due from the above -named contractor under Chapter 180, Laws of 1935, as amended, with respect to the following public works contract: CITY OF RENTON CAG 10-142, WESTVIEW LIFT STATION UPGRADES together with all other taxes, increases and penalties due from such contractor, have been paid in full or that they are, in the Department's opinion, readily collectible without recourse to the state's lien on the retained percentage. This certificate is issued pursuant to the provision of Chapter 60.28 Revised Code of Washington for the sole purpose of informing the sfate, county, or municipal officer charged with the duty of disbursing or authorizing the payment of public funds to said contractor that the Department of Revenue hereby releases the state's lien on the retained percentage provided by this Chapter for excise taxes due from said contractor. This certificate does not release said contractor from liability for additional tax that may be later determined to be due with respect to the above -mentioned contract or other activities. Dated �7 �%j i� at Olympia, Washington, State of Washington Department of Revenue Certifying Officer For tax assistance, visit dor.wa.gov or call 1-800-647-7706. To inquire about the availability of this document in an alternate format for the visually impaired , please call (360) 705-6715. Teletype (TTY) users may call 1.800-451-7985. REV 310028 (10-01-02) PUBLIC WORKS DEPARTMENT City of M E M O R A N D U M DATE: April 24, 2012 TO: Natalie Wissbrod, Finance Accounting Assistant FROM: John Hobson, Wastewater Engineering, x7279 SUBJECT: CAG 10-142, Westview Lift Station Upgrades, First National Insurance Company of America Please process the enclosed final pay estimate for this project. The project was accepted by City Council at its regular meeting on April 23, 2012. The following documents are enclosed: • Copy of the Agenda Bill for Council acceptance of project and final pay estimate • Notice of Completion of Public Works Contract • Original of final pay estimate • Affidavits of Prevailing Wages Paid (there is no Affidavit for Advanced Construction due to the company going out of business) • Statements of Intent to Pay Prevailing Wage Thank you very much for your help. Enclosures H:\File Sys\WWP - WasteWater\WWP-27-3536 Westview Lift Station Upgrades\PAY ESTIMATES\Finance notice for final payment Westview Lift Station Upgrades.doc\JDHtp RECEIVED JUN 0 2 2011 CITY OF RENTON UTILITY SYSTEMS CONSTALICTION IMC, 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 June 1, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find pay application #2 (two copies) for your review and processing. If you should have any questions and/or comments, please contact me. Yours truly, AJVanced Construction, Inc. Linda G Burkhert Controller Application and Certificate For Payment To: City of Renton 1055 S Grady Way (5th floor) Renton, WA 98055 Attention: John Hobson From: Advanced Construction Inc. 4640 Campus Place Suite 150 Mukilteo, WA 98275 Phone: 425-493-1826 Contractor's Application For Pa Change Order Summary Approved previous months by Owner Change Orders Approved this Month Date CO# Approved Totals Net Change Orders Additions Deductions 3,725.00 3,725.00 Project: Westview Lift Station Upgrades Monterey Ave Renton, WA The undersigned Contractor certifces that to the best of the Contractor's knowledge, information, and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents, tht all amounts have been paid by the Contractor for work for which previous e fcates for Payment were issued and payments receveid by the Owner, and t pay t shown herein is now due. Contractor: State of Washington County of Snohomish Subscribed and sworn to before me this Notary runoc My Commission expires: eu,Ie. Notary Public State of Washington da of 60d10. QURKHERT ISSION EXPIRES March 10, 2015 Architect's/Engineer's Certificate for Payment In accordance with the Contract Documents, based on on-wite observations and the data comprising the above application the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitiled to payment of the Amount Certified. Amount Certified: $ Original Contract Amount Net Change by Change Orders Contract Sum To Date Applicatior #02 Contract Date Projec # CAG-10-142 Total Completed and Stored to Date Less Retainage (retainage bond) Total Earned less retainage Less Previous Certificates of Payment Net Amount WSST @ 9.5% Date 12/13/10 93,000.00 3,725.00 96,725.00 67,600.00 62,100.00 (15,975.00) 46,125.00 4,381.88 Current Payment Due 50,506.88 lance to finish, including retainage Engineer by: Date: 29,125.00 This Certification is not negotiable. The Amount Certified is payable only to the Contractor named herein. Issuance, payment and acceptance are without prejudice to any rights of the Owner or Contractor under this Contract. 5/31 /2011 1 Westview Lift Station Upgrades WWP-27-3536 Pay Application TWO May 1 thru May 31, 2011 Item No Description of Work Scheduled Value Percent Complete This Period Amount This Period Previous Amount Amount To Date % Complete To Date 1 Trench Excavation $2,000.00 - - 0% 2 Mobilization/Demobilization $12,500.00 2,375.00 8,250.00 10,625.00 2.01 Bonds and Insurance $5,000.00 0% - 5,000.00 5,000.00 100% 2.02 Administration $3,500.00 25% 875.00 1,750.00 2,625.00 75% 2.03 Move E ui ment/Jobsite Set-up $3,000.00 50% 1,500.00 1,500.00 3,000.00 100% 2.04 Remove Equipment/Breakdown Jobsite $1,000.00 - - 0% 3 Wet Well Rehabilitation $47,000.00 31,250.00 - 31,250.00 3.01 By -Pass Pumping $4,000.00 100% 4,000.00 4,000.00 100% 3.02 Remove Existing Equipment $3,000.00 100% 3,000.00 3,000.00 100% 3.03 Clean Concrete Surfaces $3,000.00 100% 3,000.00 3,000.00 100% 3.04 Install New Concrete Vault Bottom $5,500.00 100% 5,500.00 5,500.00 100% 3.05 Prepare and Coat existing Concrete $12,000.00 100% 12,000.00 12,000.00 100% 3.06 Provide and Install New Equipment $15,000.00 25% 3,750.00 3,750.00 25% 3.07 Electrical $3,000.00 - - 0% 3.08 Testing $1,000.00 - - 0% 3.09 Clean-up $500.00 - - 0% 4 Valve Vault $31,500.00 12,500.00 4,000.00 16,500.00 4.01 Demolition/Excavation $6,000.00 100% 6,000.00 6,000.00 100% 4.02 Provide and Set New Vault $8,000.00 50% 4,000.00 4,000.00 8,000.00 100% 4.03 Install New Equipment $10,000.00 25% 2,500.00 2,500.00 25% 4.04 Electrical $2,000.00 - - 0% 4.05 Testing $500.00 - - 0% 4.06 Patch Asphalt and Replace Concrete $4,500.00 - - 0% 4.07 Clean-up $500.00 - - 0% Awarded Contract Amount $93,000.00 46,125.00 12,250.00 58,375.00 5 Change Order #001 $3,725.00 0% - 3,725.00 3,725.00 100% 6 7 Revised Contract Amount $96,725.00 46,125.00 15,975.00 62,100.00 Sales Tax @ 9.5% $9,188.88 4,381.88 1,517.63 5,899.50 TOTAL $105,913.88 50,506.88 17,492.63 67,999.50 Application and Certificate For Payment To: City of Renton 1055 S Grady Way (5th floor) Renton, WA 98055 Attention: John Hobson From: Advanced Construction Inc. 4640 Campus Place Suite 150 Mukilteo, WA 98275 Phone: 425-493-1826 Contractor's Application For Payment Change Order Summary Additions Deductions Approved previous months by Owner 3,725.00 Change Orders Approved this Month Date CO# Approved Totals Net Change Orders 3,725.00 Project: Westview Lift Station Upgrades Monterey Ave Renton, WA The undersigned Contractor certifices that to the best of the Contractor's knowledge, information, and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents, tht all amounts have been paid by the Contractor for work for which previous Certifi ate for Payment were issued and payments receveid by the Owner, and tha cl c rr, Lpayntent shown herein is now due. I Contractor: (State of Washington County of Snohomish Subscribed and sworn to before me this 1-. -12 D Notary Public My Commission expires: elt-�4 Original Contract Amount Net Change by Change Orders Contract Sum To Date Application #02 Contract Date Projec # CAG-10-142 Total Completed and Stored to Date Less Retainage (retainage bond) Total Earned less retainage Less Previous Certificates of Payment Net Amount Date 12/13/10 93,000.00 3,725.00 96,725.00 67,600.00 62,100.00 (15,975.00) 46.125.00 WSST @ 9.5% 4,381.88 Current Payment Due 50,506.88 l�ottpr Balance to finish, including retainage 29,125.00 St to of VIK, - Pubficday of�n1�,t0n MY COMMI.q,.g1nRHERT March I "095 EXPIRES � Architect's/Engineer's Certificate for Payment In accordance with the Contract Documents, based on on-wite observations and the data comprising the above application the Architect certifices to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality otthe Work is in accordance with the Contract Documents, and the Contractor is entitiled to payment of the Amount Certified. JAmount Certified: $ Engineer by: Date: This Certification is not negotiable. The Amount Certified is payable only to the Contractor named herein. Issuance, payment and acceptance are without prejudice to any rights of the Owner or Contractor under this Contract. 5/31 /2011 Westview Lift Station Upgrades WWP-27-3536 Pay Application TWO May 1 thru May 31, 2011 Item No Description of Work Scheduled Value Percent Complete This Period Amount This Period Previous Amount Amount To Date % Complete To Date 1 Trench Excavation $2,000.00 - - 0% 2 Mobilization/Demobilization $12,500.00 2,375.00 8,250.00 10,625.00 2.01 Bonds and Insurance $5,000.00 0% - 5,000.00 5,000.00 100% 2.02 Administration $3,500.00 25% 875.00 1,750.00 2,625.00 75% 2.03 Move E ui ment/Jobsite Set-up $3,000.00 50% 1,500.00 1,500.00 3,000.00 100% 2.04 Remove Equipment/Breakdown Jobsite $1,000.00 - - 0% 3 Wet Well Rehabilitation $47,000.00 31,250.00 - 31,250.00 3.01 By -Pass Pumping $4,000.00 100% 4,000.00 4,000.00 100% 3.02 Remove Existing Equipment $3,000.00 100% 3,000.00 3,000.00 100% 3.03 Clean Concrete Surfaces $3,000.00 100% 3,000.00 3,000.00 100% 3.04 Install New Concrete Vault Bottom $5,500.00 100% 5,500.00 5,500.00 100% 3.05 Prepare and Coat existing Concrete $12,000.00 100% 12,000.00 12,000.00 100% 3.06 Provide and Install New Equipment $15,000.00 25% 3,750.00 3,750.00 25% 3.07 Electrical $3,000.00 - - 0% 3.08 Testing $1,000.00 - - 0% 3.09 Clean-up $500.00 - - 0% 4 Valve Vault $31,500.00 12,500.00 4,000.00 16,500.00 4.01 Demolition/Excavation $6,000.00 100% 6,000.00 6,000.00 100% 4.02 Provide and Set New Vault $8,000.00 50% 4,000.00 4,000.00 8,000.00 100% 4.03 Install New Equipment $10,000.00 25% 2,500.00 2,500.00 25% 4.04 Electrical $2,000.00 - - 0% 4.05 Testing $500.00 - - 0% 4.06 Patch Asphalt and Replace Concrete $4,500.00 - - 0% 4.07 Clean-up $500.00 - - 0% Awarded Contract Amount $93,000.00 46,125.00 12,250.00 58,375.00 5 Change Order #001 $3,725.00 0% - 3,725.00 3,725.00 100% 6 7 Revised Contract Amount $96,725.00 46,125.00 15,975.00 62,100.00 Sales Tax @ 9.5% $9,188.88 4,381.88 1,517.63 5,899.50 TOTAL $105,913.88 50,506.88 17,492.63 67,999.50 PUBLIC WORKS DEPARTMENT city of M E M O R A N D U M DATE: February S, 2011 TO: Natalie Wissbrod, Finance Accounting Assist FROM: John Hobson, Wastewater Utility, x7279 Z` SUBJECT: CAG-10-142 - Westview Lift Station Upgrades Project: Retainage Bond for Advanced Construction Inc. Attached are two (2) originals of the Retainage Bond for the above referenced project along with a copy of their Vendor Setup form. Attachments H:\File Sys\WWP - WasteWater\WWP-27-3536 Westview Lift Station Upgrades\BID INFO\Retainage Bond-Westview LS Upgrades.doc\JDHtp .w Bond No. 69S301498 RETAINAGE BOND KNOW ALL MEN BY THESE PRESENTS that we Advanced Construction, Inc. 1 a corporation under and by virtue of the laws of the State of Washington and authorized to do business in the State of Washington, as Principal, and First National Insurance Compan a ofAtnerieft corporation organized and existing under the laws of the State of Washington and authorized to transact business of surety in the State of Washington, as Surety, are . jointly and severally held and bound unto City of Renton hereinafter referred to as Obligee, as Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created by RCW 60.28 and their heirs, executors, administrators, successors and assigns, in the penal sum of FIVE THOUSAND NINETY-ONE AND 75/100THS Dollars ( $5,091.75 ) plus 5% of any increases in the contract amount that have occurred or may occur, due to change orders, increases in the quantities or the addition of any new item of work. WHEREAS, on the day of , the said Principal herein executed a contract with City of Renton for $5,091.75 Release of Retainage Bond to City of Renton for Westview Lift Station Upgrades WHEREAS, said contract and RCW 60.28 require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the work, hereinafter referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under Chapter 60.28 RCW. NOW THEREFORE, this obligation is such that the Surety, its successors and assigns are held and bound unto the Obligee and unto all beneficiaries of the trust fund created by RCW 60.28.011(1) in the aforesaid sum. This bond, including any proceeds therefrom, is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in Chapter 60.28 RCW. The condition of this obligation is also that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund created pursuant to Chapter 60.28 RCW, to the Obligee, and indemnify and hold the Obligee harmless from any and all lost, costs and damages that the Obligee may sustain by release of said retainage to the Principal, then this obligation shall be null and void, provided the Surety is notified by the Obligee that the requirements of RCW 60.28.021 have been satisfied and the obligation is duly released by the Obligee. Retainage Bond No. 69S301498 Page 2 of 2 IT IS HEREBY DECLARED AND AGREED that the Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liability for any act, omission or defenses of any kind or nature that would not also discharge the Principal. IT IS HEREBY FURTHER DECLARED AND AGREED that this obligation shall be binding upon and inure to the benefit of the Principal, the Surety, the Obligee, the beneficiaries of the trust fund created by Chapter 60.28, Revised Code of Washington (RCW) and their respective heirs, executors, administrators, successors and assigns. IN WITNESS WHEREOF, said Principal and said Surety have caused these presents to be duly signed and sealed this 20th day of December , 2010 Advanced Construction, Inc. By e o :. �n^cipar p cL ; 4Z �� Z First National Insuran6� Con'i pica 'E�00� od%0t��`�� Surety y By: Theresa A. Lamb Attorney -in -fact Ls�ert POWER First National Insurance Company of America 1001 4th Avenue OF ATTORNEY Suite 1700 Seattle, WA 98154 KNOW ALL BY THESE PRESENTS: No. 7351 That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, does hereby appoint ************STEVEN K. BUSH; BRANDON K. BUSH; M.J. COTTON; JIM W. DOYLE; CHAD M. EPPLE; JULIE M. GLOVER; DARLENE JAKIELSKI; JIM S. KUICH; THERESA A. LAMB; MICHAEL A. MURPHY; NANCY J. OSBORNE; ANDY D. PRILL; S.M. SCOTT; STEVE WAGNER; Bothell, Washington*************************************** its true and lawful attorney(s)-in-fact, with full authority to execute on behalf of the company fidelity and surety bonds or undertakings and other documents of a similar character issued by the company in the course of its business, and to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as if such instruments had been duly executed by its regularly elected officers at its home office. IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents this 21 st day of March 1 2009 pixa e,kll Dexter R. Legg, Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of -attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of -attorney appointment is in full force and effect, the signature'of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg ,Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of this corporation, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal -of said corporation "� this _() % day ofV1 , D. SEAL 1928 Dexter R. Legg, Secretary S-1049/DF 3/09 • • WEB PDF City of Renton — Finance/IT Department1055 VENDOR SETUP FORM Renton, WA 98057 South Grady Woy— 5`h Floor To be filled out by vendor ONLY [ New Vendor Rent ❑ Reactivate Vendor ❑ Address Change Vendor No: City of Renton Contact: Citv of Renton Department: To add your business to our vendor file, please complete all sections of this form and return by fax (425.430.6957) or U.S. mail. Website: www.i-entonwa.gov Tax ID #: 91-6001271 Phone: 425-430-6919 or 425-430-6930 E-mail: nwissbrod6Drentonwa.Rov (Natalie); ccommodoreCDrentonwa.aov (Casaundra) — Note: EFT (electronic fund transfer) payments available. Please visit our ivebsite for more information. An incomplete form will create a delay in our payment(s) to you, and your payment(s) could be subject to the ired back uo hold AD46 r41 > C-CIy !rliU-7i/1-A Na as it appears on check (NO ABBREVIATIONS) �� gu,C.'hrn3)i.i S I'l- "�UITC 150 Payment Address m L� k I LT>= c, -vl l a ayi) ,5 City State Zip 41,-,-4? i SZC Ext. Phone Number/Extension Doing Business As (if different than name on check) Business Address City State Zip Accounts Receivable Contact (check the appropriate box) ❑acorporation ❑ Government Agency ❑ Individual/Sole Proprietor ❑ Non -Profit ❑ Partnership Will you provide medical services to the City of Renton?..................................................................:............................................... ❑Yes [gNo Will you provide legal services to the City of Renton?........................................................................................................................ [_]Yes QNo Will you provide other services to the City of Renton (other than medical or legal)?........................................................................ ❑Yes QNo Will you provide parts, supplies, or materials to the City of Renton.................................................................................................. 10Yes ❑No Do you pay sales tax to the State of Washington?............................................................................................................................. ®,Yes ❑No © if exempt from Form 1099 reporting, and check your qualifying exemption reason below: R 1. Corporation, except there is no exemption for medical and healthcare payments or payments for legal services. ❑ 2. Tax Exempt Charity under 501(a), or IRA ❑ 3. The United States or any of its agencies or instrumentalities ❑ 4. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions ❑ S. A foreign government or any of its political subdivisions Name (Owner of the Tax Payer Identification Number (EIN or SSN) as name appears on IRS of Social Security Administration Records): A --Y ) Social Security Number: or Federal TIN: C / i Z Z--- *Required by City of Renton Municipal Code, Business Regulation State of Washington U.B.I. #: *Renton Business License #: #5-5-3. /� a L 3 �7 Questions? Contact Business Licensing at 425-430-6851, or email Iweldon@rentonwo.gov Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me) and, 2. 1 am not subject to backup withholding becausei (a) 4am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup SJt6olding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup 4tAolding. 1 Signature: _J J Date 1 Printed Name: AT \Smlih �RUSldQi1t I I am a U.S. person (including a U.S. resident alien): Yes ❑ No C1nocumcnis and ScuinyUlRoy.RENTO,\' Desklol l%Vcndor form Aoc 07129i20o9 10:20:DO AN12/21/2007 RECEIVED APR 2 2 2011 CITY OF hIENTON UTILITY SYSTEMS rAADII-A�� C O NST;Z UC T IOhI INC. 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 April 20, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending April 9 and 16, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advanced Construction, Inc. V Linda G Burkhert Controller Statement of Compliance 1k t Date: APRIL 20, 2011' 1, Linda G Burkhert, Controller do hereby state: Contract Number. CAG 10-142 (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 10 day of APRIL, 2011 and ending the 16 day of APRIL, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 ( X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller SIGNATURE The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Page ! Advanced Construction, Inc. 4640 Campys Placs Suite 150 Mukilteo, WA 98275 425 493-1826 Pay Period Date: 04/16/11 Week Ending: 04/16/11 Payroll No: 2 Certified Payroll Report Contract #: CAG 10-142 Job No: 229 IL Job Name: Westview Lift Station # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 10 11 12 13 14 15 16 Total Rate Gross Pay Total Job Gross 0.00 Page 2 Statement of Compliance 4 Date: APRIL 13, 2011 Contract Number- CAG 10-142 I, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 3 day of APRIL, 2011 and ending the 9 day of APRIL, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948-63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 anv 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 ( X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller SIGNATURE , The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1 1 of Title 18 and Section 231 of Title 31 of the United States Code. Page I Abvanced e.onstruction, Inc. Pay Period Date: 04/09/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 04/09/11 Job No: 229 f. Suite 150 Payroll No: 1 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 03 04 05 06 07 08 09 Total Rate Gross Pay Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 261.00 Gross ' 1,533.58 16723 4th Dr SE '---2654 S 0.00 0.00 0.00 0.00 0.00 3.00 0.00 3.00 40.03 120.09 FICA 89.19 Taxes 370.06 State W/H 0.00 Deducts 179.48 Bothell, WA, 98012 General Laborer Local W/H 0.00 Add-Ons -255.00 Other Job Pay Wcomp/Sdi 19.87 Net Pay 729.04 Child Supp 80.07 Check #: 4480 Field Medi 54.41 Truck Use 45.00 Total Job Gross 120.09 Nine 2 Aek C0N5T;ZUCTION INC. 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 April 27, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending April 23, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advanced Construction, Inc. Linda G Burkhert Controller RECEIVED APR 2 8 2011 CITY OF RENTON UTILITY SYSTEMS Statement of Compliance Date: APRIL 27.2011 Contract Number: CAG 10-142 1, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 17 day of APRIL, 2011 and ending the 23 day of APRIL, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of labor under the Copeland Act, as i amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 (X) 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 employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH O 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller SIGNATORE , The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Pag" 1 Advanced Construction, Inc. Pay Period Date: 04/23/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 04/23/11 Job No: 229 Suite 150 Payroll No: 3 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 17 18 19 20 21 22 23 Total Rate Gross Pay + Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 245.00 Gross 1,471.05 16723 4th Dr SE -**-2654 S 0.00 0.00 3.50 0.00 0.00 0.00 0.00 3.50 40.03 140.11 FICA 85.65 Taxes 347.85 State W/H 0.00 Deducts 179.48 General Laborer Local W/H 0.00 Add-Ons 45.00 Bothell, WA, 98012 Other Job Pay Wcomp/Sdi 17.20 Net Pay 988.72 Child Supp 80.07 Check #: 4503 Field Medi 54.41 Truck Use 45.00 Total Job Gross 140.11 Page 2 RECEIVED MAY 062011 CITY OF RENTON UTILITY SYSTEMS CCN6 i;ZLN=TICjN INC. 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 May 4, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending April 30, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advanced Construction, inc. 1�bl-91,1 �ARl Linda G Burkhert Controller Statement of Compliance Date: MAY 4, 2011 Contract Number: CAG 10-142 I, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 24 day of APRIL, 2011 and ending the 30 day of APRIL, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 (X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller , SIGNATURE ZLEi� The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Page Advanced Construction, Inc. 4640 Campus Place Suite 150 Mukilteo, WA 98275 425 493-1826 Pay Period Date: 04/30/11 Certified Payroll Report Week Ending: 04/30/11 Payroll No: 4 Contract #: CAG 10-142 Job No: 229 Job Name: Westview Lift Station N # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Total:. Employee Work Class 24 25 26 27 28 29 30 Total Rate Gross Pay Total Job Gross 0.00 �e tJU%/�' 1)52 Page 2 RECEIVED MAY 1 2 2011 CITY OF RENTON UTILITY SYSTEMS CON5T;ZLJCTION INC, 4640 Campus Place Suitt 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 May 11, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending May 7, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advance] Construction, Inc. Linda G Burkhert Controller Statement of Compliance Date: MAY 11, 2011 Contract Number. CAG 10-142 1, Linda G Burkhert, Controller do hereby state: (1) That 1 pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 1 day of MAY, 2011 and ending the 7 day of MAY, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 ( X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller IGNATURE , The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. SeeSection 1001 of Title 18 and Section 231 of Tit!e 31 of the United States Code. Page I AdvancetrCunstruction, Inc. Pay Period Date: 05/07/11 Certified Payroll Report Contract#: CAG 10-142 4640 Campus Place Week Ending: 05/07/11 Job No: 229 Suite 150 Payroll No: 5 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 01 02 03 04 05 06 07 Total Rate Gross Pay Total Job Gross 0.00 l(1.1�- f ErzFo0A -, P,ip-2 C0M6T;ZLICTK:0 N INC. 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 RECEIVED May 23, 2011 MAY 2 6 2011 CITY OF RENTON Mr. John Hobson UTILITY SYSTEMS City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending May 14, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advance] Construction, Inc. Linda G Burkhert Controller Statement of Compliance Date: MAY 23, 2011 Contract Number: CAG 10-142 1, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 8 day of MAY, 2011 and ending the 14 day of MAY, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357,40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 ( X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller SIGNATURE The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 106 1 of Title 18 and Section 231 of Title 31 of the United States Code. Page 1 Advanced Construction, Inc. Pay Period Date: 05/14/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 05/14/11 Job No: 229 Suite 150 Payroll No: 6 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 08 09 10 11 12 13 14 Total Rate Gross Pay Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60.04 0.00 Fed W/H 0.00 Gross 0.00 16723 4th Dr SE * -**-2654 S 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.03 0.00 FICA 0.00 Taxes 0.00 State W/H 0.00 Deducts 0.00 Bothell, WA, 98012 General Laborer Local W/H 0.00 Add-Ons 0.00 Other Job Pay Wcomp/Sdi 0.00 Net Pay 0.00 Child Supp Check #: 4547 Field Medi Total Job Gross 0.00 \[© / J) dw C 1 Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 278.00 Gross 1,601.21 16723 4th Dr SE -**-2654 S 0.00 9.50 8.00 6.50 10.00 6.00 0.00 40.00 40.03 1,601.21 FICA 93.01 Taxes 384.90 State W/H 0.00 Deducts 179.48 Bothell, WA, 98012 General Laborer Local W/H 0.00 Add-Ons 45.00 Other Job Pay Wcomp/Sdi 13.89 Net Pay 1,081.83 Child Supp 80.07 Check #: 4555 Field Medi 54.41 Truck Use 45.00 Total Job Gross 1,601.21 Reece, Christopher T Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 46.36 0.00 Fed W/H 0.00 Gross 0.00 14800 Interurban Ave S -**-8048 S 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30.91 0.00 FICA 000 Taxes 0.00 State W/H 0.00 Deducts 0.00 GENERAL LABORER Local W/H 0.00 add-Ons 0.00 Tukwilla, WA, 98168 Other Job Pay WcomplSdi 0.00 Net Pay 0.00 Vac Union Check #: 4548 Union Dues Total Job Gross 0.00 !� Page 2 Advanced Construction, Inc. Pay Period Date: 05/14/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 05/14/11 Job No: 229 Suite 150 Payroll No: 6 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 08 09 10 11 12 13 14 Total Rate Gross Pay Reece, Christopher T Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 189.00 Gross 1,236.41 14800 Interurban Ave S -"-8048 S 0.00 4.00 10.00 9.50 10.00 6.50 0.00 40.00 30.91 1,236.41 FICA 69.86 Taxes 278.94 State W/H 0.00 Deducts 73.60 Tukwilla, WA, 98168 GENERAL LABORER Local W/H 0.00 Add-Ons 0.00 Other Job Pay Wcomp/Sdi 20.08 Net Pay 883.87 Vac Union 40.00 Check #: 4556 Union Dues 32.00 Fair Contr 1.60 Total Job Gross Hours Fringe Description Regular Overtime Double Time All Total Rate Type H&W 40.00 0.00 0.00 40.00 200.00 5.0000 All Hours LECET 40.00 0.00 0.00 40.00 2.81 0.0700 All Hours PENSION 40.00 0.00 0.00 40.00 144.00 3.6000 All Hours TRAIN 40.00 0.00 0.00 40.00 18.01 0.4500 All Hours Total Fringe: 364.82 1,236.41 Page 3 C0145TALJCTION INC. 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 RECEIVED May 25, 2011 MAY 2 7 2011 CITY OF RENTON Mr. John Hobson UTILITY SYSTEMS City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending May 21, 2011. If you should have any questions and/or comments, please contact me. Yours truly, AJvanceJ Construction, Inc. Linda G Burkhert Controller Statement of Compliance Date: MAY 25, 2011 Contract Number. CAG 10-142 I, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 15 day of MAY, 2011 and ending the 21 day of MAY, 2011, all persohs employed on said 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 Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 ( X) 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 employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH O 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) 17XPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller SIGNATURE The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Page I Advanced Construction, Inc. Pay Period Date: 05/21/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 05/21/11 Job No: 229 Suite 150 Payroll No: 7 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals Social Security SUN MON TUE WED THU FRI SAT Employee Work Class 15 16 17 18 19 20 21 Total Rate Gross Pay Deductions Totals Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 210.00 Gross 1,328.44 16723 4th Dr SE -**-2654 S 0.00 4.00 0.00 7.50 9.50 0.00 0.00 21.00 40.03 840.64 FICA 77.59 Taxes 301.67 General Laborer State W/H 0.00 Deducts 179.48 Bothell, WA, 98012 Local W/H 0.00 Add-Ons 45.00 Other Job Pay Wcomp/Sdi 14.08 Net Pay 892.29 Child Supp 80.07 Check #: 4562 Field Medi 54.41 Truck Use 45.00 Total Job Gross 840.64 Reece, Christopher T Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 119.00 Gross 958.22 14800 Interurban Ave S -**-8048 S 0.00 4.00 0.00 7.50 9.50 0.00 0.00 21.00 30.91 649.12 FICA 54.14 Taxes 182.65 GENERAL LABORER State W/H 0.00 Deducts 57.04 Tukwilla, WA, 98168 Local W/H 0.00 Add-Ons 0.00 Other Job Pay Wcomp/Sdi 9.51 Net Pay 31.00 718.53 Vac Union 24.80 Check #: 4563 Union Dues Fair Contr 1.24 Total Job Gross 649.12 Hours Fringe Description Regular Overtime Double Time All Total Rate Type H&W 21.00 0.00 0.00 21.00 105.00 5.0000 All Hours LECET 21.00 0.00 0.00 21.00 1.48 0.0700 All Hours PENSION 21.00 0.00 0.00 21.00 75.60 3.6000 All Hours TRAIN 21.00 0.00 0.00 21.00 9.46 0.4500 All Hours Total Fringe: 191.54 Pine 2 RECEIVED JUN 0 3 2011 CITY OF RENTON UTILITY SYSTEMS CQNSTAUCTMON INC, 4640 Campus Place Suite 150 Mukilteo, WA. 98275 Telephone: 425-493-1826 Facsimile: 425-493-1827 June 2, 2011 Mr. John Hobson City of Renton Fifth Floor 1055 S Grady Way Renton, WA 98055 Re: Westview Lift Station Contract #CAG-10-142 Dear Mr. Hobson: Attached please find Advanced Construction's certified for Week Ending May 28, 2011. If you should have any questions and/or comments, please contact me. Yours truly, Advance] Construction, Inc. Iv�.GlCG%�gkGTi��!•'YP� Linda G Burkhert Controller Statement of Compliance Date: TUNE 2, 2011 Contract Number: CAG 10-142 I, Linda G Burkhert, Controller do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Construction, Inc. on the Westview Lift Station, that during the payroll period commencing on the 22 day of MAY, 2011 and ending the 28 day of MAY, 2011, 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 indirectly to or on behalf of said Advanced Construction, Inc. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C.3145), and described below: Medicare, Social Security, Federal and State Unemployment (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 ( X) 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 employees, 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) EXPLANATION REMARKS NAME AND TITLE Linda G Burkhert, Controller IGNATURE The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Sectio 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Page I Advanced Construction, Inc. Pay Period Date: 05/28/11 Certified Payroll Report Contract #: CAG 10-142 4640 Campus Place Week Ending: 05/28/11 Job No: 229 Suite 150 Payroll No: 8 Job Name: Westview Lift Station Mukilteo, WA 98275 425 493-1826 # Exemptions Hours Check Totals ' Social Security SUN MON TUE WED THU FRI SAT Deductions Totals Employee Work Class 22 23 24 25 26 27 28 Total Rate Gross Pay Gardner, Zane Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 243.00 Gross 1,461.10 16723 4th Dr SE -**-2654 S 0.00 8.50 8.00 8.00 8.00 4.00 0.00 36.50 40.03 1,461.10 FICA 85.10 Taxes 342.02 State W/H 0.00 Deducts 178.32 Bothell, WA, 98012 General Laborer Local W/H 0.00 Add-Ons 45.00 Other Job Pay Wcomp/Sdi 13.92 Net Pay 985.76 Child Supp 80.07 Check #: 4575 Field Medi 53.25 Truck Use 45.00 Total Job Gross 1,461.10 Reece, Christopher T Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H 162.00 Gross 1,128.22 14800 Interurban Ave S *-**-8048 S 0.00 8.50 8.00 8.00 8.00 4.00 0.00 36.50 30.91 1,128.22 FICA 63.75 Taxes 239.05 State W/H 0.00 Deducts 65.34 Tukwilla, WA, 98168 GENERAL LABORER Local W/H 0.00 Add-Ons 0.00 Other Job Pay Wcomp/Sdi 13.30 Net Pay 823.83 Vac Union 36.50 Check #: 4583 Union Dues 27.38 Fair Contr 1.46 Total Job Gross 1,128.22 Hours Fringe Description Regular Overtime Double Time All Total Rate Type H&W 36.50 0.00 0.00 36.50 182.50 5.0000 All Hours LECET 36.50 0.00 0.00 36.50 2.56 0.0700 All Hours PENSION 36.50 0.00 0.00 36.50 131.40 3.6000 All Hours TRAIN 36.50 0.00 0.00 36.50 16.43 0.4500 All Hours Total Fringe: 332.89 Page 2