PrimeCom USA LLC 5/6/2022 - Laserfiche WebLink

Department of Labor and Industries STATEMENT OF INTENT TO Prevailing Wage s,t• �Tqr,o� PAY PREVAILING WAGES ;.:.,� 360)902-5335 0 ail Public Works Contract t+ww.Ini.wa.Qov/1'radesLicensing/PrevWage 'fr z n• Fill in all blanks or the form will be returned for correction �y,�lase aov $40.00 Filing Fee Required (see Please llowinstructions).n Intent ID#(Assigned by L&I) 1227554 • Please allow a minimum of 10 working days for processing. • Once approved,your form will be posted online at Your Company Information Awarding Agency Information Your Company Name Project Name Contract Number PRIMECOM USA LLC CHAIN-LINK FENCE,GATE& 2022-009 AUTOMATED OPERATOR INSTALLATION—FOREST PARK Your Address Awarding Agency P.O.BOX 3026 EVERETT,CITY OF City State Zip+4 Awarding Agency Address ISSAQUAH WA 98027 3200 CEDAR ST EVERETT,WA-98201 Your Contractor Registration Your UBI Number Awarding Agency Contact Name Phone Number Number 603326240 Bert Cueva 4252578903 PRIMEUL869KO Your Industrial Insurance Account Number County Where Work Will Be Performed City Where Work Will Be Performed 27421200 Snohomish Everett Your Email Address(required for Your Phone Number notification of approval) 4256513041 michael.jruprimecst.com Additional Details Contract Details our Expected Job Start Date(mm/dd'vyyy) Bid Due Date(Prime Contractor's) Award Date(Prime Contractor's) 05/02/2022 03/17/2022 04/13/2022 Total Dollar Amount of Your Contract Job Site Address/Directions (including sales tax)or indicate time and $57510.00 ❑ T&M 802 E. Mukilteo Blvd Everett,WA 98201 materials,if applicable. Prime Contractor's Company Information Hiring Contractor's Company Information Prime Contractor's Company Name Prime Contractor's Intent Number Hiring Contractor's Company Name PRIMECOM USA LLC 1227554 Prime Contractor's Registration Prime Contractor's UBI Number Hiring Company's Contractor Registration Number Hiring Contractors UBI Number Number 603326240 PRIMEUL869KO Employment Information Do you intend to use ANY Will employees perform work subcontractors? Yes ®No on this project? ®Yes No Will ALL work be subcontracted? ❑Yes No Do you intend to use apprentice ❑Yes No employees? Number of Owner/Operators who own at least 30%of the company who will perform work on this project: ®None(0) Done(1) ❑Two(2) ❑Three(3) Crafts/Trades/Occupations—(Do not list apprentices. They are listed on the Affidavit of Wages Paid only.)If an employee works in more than one trade, Number of Rate of Hourly Rate of Hourly Usual("Fringe") ensure that all hours worked in each trade are reported below. For additional Workers Pay Benefits crafts/trades/occupations please use Addendum A. 0.00 Snohomish-Fence Erectors-Fence Laborer 2 46.29 0.00 Snohomish-Fence Erectors-Fence Erector 2 46.29 Signature Block I hereby certify that I have read and understand the instructions to complete this form and that the information,including any addenda,are correct and that all workers I emploc on this Public Works Project will be paid no less than the Prevailing Wage Rate(s)as detennined by the Industrial Statistician of the Department of Labor and Industries. Print Name: Print Title: Signature: Date: For L&I Use Only Approved by signature of the Department of Labor and Industries Industrial Statistician NOTICE: If the prime contract is at a cost of over one million dollars($1,000,000.00),RCW 39.04.370 requires you to complete the EHB 2805(RCW 39.04.370)Addendum and attach it to your Affidavit of Wages of Paid when your work on the project concludes. This is only a notice.The EHB 2805 Addendum is not submitted with this Intent. SAMPLE-F700-029-000 Statement of Intent to Pay Prevailing Wages 03-2011