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INDUSTRiAL STATISTICIAN
Department of Labor & Inirtustries
Employment Standards Sections
Olympia� WA 98504-0631
(206) 751-4019
Contract Awarding Agenc)
City of Renton DPW
Address 200 Mill Ave. So.
Renton, WA 98055
Ttlephonc Number 206/235-2631
AFFIDAVIT OF
WAGES PAID
ON PUBLIC WORKS CONTRACT
Contract/BPW Number J- �r - ITO
Date Bid Was Due 6/10/86
10/6/86
Date Contract Awarded
Date Work Completed 3/26/87
County in Which Work Performed King
Prime Contractor Coral Construction Company
Your Contractor's Registration Certificate No. CO-RA-LC-C21 1 NZ
Was a Statement of Intent Fil--d
For this project? Yes No
In compliance with RCW 39.12.040 1, the undersigned, being a duly authorized representative of
Coral Construction Company P.O. Box 347 Wilsonville, OR 97070
(C—ractor ., Sub—t—or) (Add—)
do hereby certify that the following rates of hourly wage and hourly fringe benefits have been paid to the laborers,
workmen and mechanics employed by me upon the project described above and that no laborer, workman or me-
chanic has been paid less than the "prevailing rate of wage" as determined by the Industrial Statistician of the
Department of Labor and Industries.
List below each classification of labor employed by you upon the project described above and the rate of hourly pay
and hourly fringe benefits paid to each classification.
PLEASE NOTE
If apprentices have been employed on this project, provide this additional information: name, registration number, stage
of progressi" and date of hiring.
cinift
Operator Frm
Operator
Laborers
GR IV
GR IV
GR III
N Attach Additional sheets as Necde&
Subscribed and sworn to before me
this 13th __ day of
87
19--
lo:W ..d for the Stwe fX5JQW, residmg
INSTRUCTIONS:
Riae of
Howly Pay
Rate of Ho.1y
Fruige B-6. P.W
17.88 4.21
17.38 4.21
3.43
CITV OF RENTON
R E C E I V E D
APR 3 0 1987
PURCHASING DEPT.
Cor/eT-Construction Ccmpany
�Vice Pres.
L & I U- Omiy
hereby certify that according to the wage rates an ! fringe benefits beret. sworn
o the p-iling wage requirements of RCW 39.12.040 haw been satiilmd
INDUSTRIAL STATISTICIAN'
DEPARTMENT OF LABOR AND INDUSTRIES
APR 2 3 '87
1. Pursuant to RCW 39.12.040 copies of this form must be completed by the contractor and each of his sub-
contractor .
2. Complete this form in triplicate and have it notarized.
3. Submit all forms for approval to: Department of Labor and Industries, Employment Standards Section, Olympia,
W �; . QQ CAA � I t
as ng on -
4. Mail an approved ciLpy to the Contract Awarding Public Agency
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of tb
CONTRACTORS. This is required by law and payments can not lawfully be made until such affidavits a
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