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12/08/2008 14:03 FAX [6001/002 <br /> • <br /> Affidavit of Wages Paid <br /> L f . Gj Ltj Page 1 of 2 <br /> P,tj}3��rstCiI tt� ' <br /> ; a Prevailing Wage Section <br /> L <br /> Al'01 Eta Vis" y Department of Labor& <br /> n,�0 Affidavit of Wages Paid Industries <br /> ril..lSs Rii -1-‘44/ PO Box 44540 <br /> Olympia,WA 98504-4540 <br /> Received: Affidavit Id: <br /> 12/03/2008 200305 Status: <br /> --. _ Approved on 12/08/2008 <br /> COMPANY <br /> Company CROSBY RESTORATION INC <br /> Information: CROSBRI044NG <br /> 601 159 123 <br /> License History 253,969-03 <br /> 1801 130TH AVE NE <br /> IndustrialPremiumStIn ut rafceatus BELLEVUE,WA 98005 <br /> (425)885-5557 <br /> Payment Type: Electronic <br /> Company Electronic <br /> Signature: <br /> PROJECT <br /> Public Agency: EVERETT,CITY OF <br /> 3200 CEDAR ST <br /> EVERETT,WA 98201 <br /> County: SNOHOMISH Multiple Counties?No • <br /> City: EVERETT <br /> Project Name: EVERETT SENIOR ACT.CNT <br /> Contract Number: TCMGEC*993J6 • <br /> Date Intent Filed: 05/27/2008 <br /> Bid Due Date: 04/01/2008 <br /> Award Date: -04/10/2008 .-..-- ............. -..• -.-:-.... <br /> paw-Work' 09/30/2008 <br /> Completed: <br /> Prime Contractor: TCM CONSTRUCTION <br /> TCMCOC*950QQ <br /> (253)460-9277 <br /> Did Your Company <br /> Hire Subcontractors <br /> To Perform All <br /> Work? No <br /> Did Your Company <br /> Hire Any <br /> Subcontractors? No <br /> $Amount: $59,193.09 <br /> Number of Owners: 0 <br /> Did Employees <br /> Performed Work on Yes <br /> This Project? <br /> Filed by: George Brewer <br /> EMPLOYEES' WAGES <br /> Journey Level Trades/Occupations <br /> County i 7 Trade Occupation <br /> Wage Fringe <br /> g 9 .Wor Hou <br /> SNOHOMIE¢DICK AND MARBLE MASONS JOURNEY LEVEL 43 <br /> $33.16 $122.166$11.813 4273.5 <br /> 434 <br /> SNOHOMI BRICK AND MARBLE MASONS JOURNEY LEVEL $32.16 34 <br /> ittnc•//fnrtrPcc 1%ra <br />