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Category 2: Sensitive information <br />I CiR/ of Everctt <br />Construction anagementE <br />EVERETT Affidavit of Amounts Paid DBE Participants <br />THIS FORM IS REQUIRED WITH THE FINAT ESNMATE <br />FROM THE PRIME CONTRACTON ON Att PROJECTS <br />Contractor: R.L. Alia Company Date:721L12025 <br />Address: 10831 SE 181't St City: Renton state: wA Zip Code: 90855 <br />Project Title: <br />Beverly Lake Water Quality Retrofit <br />Project Work Order f : <br />uP-3745 <br />FederalAid Project Number (if Federally Funded) <br />N/A <br />Contract Bid Pricei <br />91,17s,01s.00 <br />DBE Condition of Award: <br />DBE Participant <br />Name and Address <br />Ethnic code Contract <br />Type <br />Bid ltem <br />No.(s) <br />Amount Paid Participants <br />(lncluding retainage held) <br />WCCL Systems LLC <br />4008 Elwood Dr W <br />university Place, wA 98455 <br />H <br />5 <br />s <br />27 <br />23 <br />s66,s89.10 <br />s7,90s.00 <br />Ethnic code: <br />B " Black <br />H = Hlspanlc <br />A = Aslan American <br />I = Amerlcan lndian <br />Alaskan Native <br />O s Other <br />Contract Type: <br />5 = Subcontrador <br />M = Materlal 5upplier <br />JV ' Jolnt Venture <br />thereof, <br />uthe rsnde dot,ce tnthated,tgn ronconnectherebyrtify theon for ic thh ts mstate ent sulsproject bmitted, <br />heac OBE contracted hameparticipant mouaby snts nhow bfor d itempa o ns listeds,portio <br />Affidavit <br />with all work <br />ing at <br />ure <br />I <br />/ <br />OF <br />Titte fResoctr <br />ed and sworn before me this: 22 ao <br />kr,..t <br />Notary Public in end for the State of Washington <br />day of <br />Category 2: For official use only/ dirclosu.e permissible by law. <br />S ru/e <br />Hot Mix Pavers lnc <br />4400 s 131't Pt <br />Tukwila, WA 98158 <br />Total DBE Participation Achieved <br />574,494.ro