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3 <br /> 'ABOR STANDARDS COMPLIANCE REPORT <br /> NSP1 grantee certifies that federal labor standards do not apply to this NSP1 project <br /> (the project did not include construction work or construction contracts in excess of$2,000, <br /> OR the project involved rehabilitation of residential property containing fewer than 8 housing units) <br /> This From Must Be Used for Restitution (Underpayments) of$.00 to $999.99 <br /> (See Federal Labor Standards Handbook 1344.1, Paragraph g., page 3-15, for amounts totaling $1,000 or more) <br /> Agency Name and Address: City of Everett, 2930 Wetmore Ave, Everett, WA 98201 <br /> Description of Work: <br /> HUD Program or Source of Funds: NSP1 Contract#: 08-F6401-004 <br /> Prime Contractor: • Contract Amount: $ <br /> Pre-Construction Conference Date: • Location: <br /> Federal Labor Standards Provisions Included in Specs: http://www•hud.gov/offices/admmudclips/forms/fles/4o1c.pdf <br /> Wage Determination Included in the Specs: Number: <br /> Number of Modifications: <br /> Are Contractor(s) Payroll Certifications Submissions Current &Complete? <br /> Number of Construction Wage Interviews (HUD-11) Completed: <br /> Number of Trades Interviewed: <br /> Were Any Violations Discovered and Resolved? Number: <br /> Number of Employees Involved: Number of Subs Involved: <br /> Total Amount of Underpayments: $ Contract Work Hours &Safety Standards Act <br /> (overtime underpayments): <br /> Briefly Describe Any Labor Standards Complaints &Resolutions: <br /> Is any contractor retainage held at this time? 'Amount: $ <br /> SUBCONTRACTOR(S)WHO WORKED ON THIS PROJECT <br /> Name Address • Contract Amount Type of Work <br /> $ <br /> Note: Please attach more pages, if needed, for any additional information. <br /> I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT ALL LABORERS AND MECHANICS EMPLOYED ON THIS CONSTRUCTION CONTRACT <br /> WERE PAID IN ACCORDANCE WITH THE LABOR PROVISIONS,EXCEPT AS NOTED. THERE ARE NO OUTSTANDING OR UNRESOLVED <br /> LABOR STANDARDS,UNDERPAYMENTS,COMPLAINTS,OR DISPUTES. <br /> Signature: JAL, / /V A Name: J Me5i-or <br /> Date: 10/24/1 2 Title: 60 WWI(-1-,.j t eV e,be egl: SNX-6-i51- <br /> RECF i , <br /> 007 25 701Z <br /> NSP1 Closeout Performance Report Department Co nmerc29 Page 11 of 12 <br />