request #1 & 2 2-6-04 001
City of Yelm
Memo
To: Barb, Senior Accounting Clerk
From: Shelly, City Administratoh( ~.Y
CC: Gary Carlson, City Hall In(TP,rovement Project Manager
Date: February 6, 2004
Re: Payment Request #1 AND #2 for A.M. James Co., Inc. for City Hall Improvement
Project
Attached you vdll find Payment Requests #1 and #2 for the City Hall Improvement Project. Both
payments have been reviewed by Project Manager Gary Carlson and myself and are AUTHORIZED
for payment.
Please process a voucher in the amount of $47,460.60 to A.M. James Company, Inc. with
the February 111° batch of vouchers.
Please pay out of the Municipal Building Fund Line #302 594 19 62. Please give voucher to Gary
Carlson who will hand deliver payment to Jim Wright with A.M. James Co.
Thank you.
p oy d f r P yment:
ate:
Project: _ (n r .vii - o - f-
BARS # i~ c el
BARS #
1
FA% NO. 2532-651615 Feb. OS 2094 09:19AM PL
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Department of Labor and l ndustries STATE"NNT OF INTENT TO
Prevailing Wage PAY PREVAILING WAGES
(360) 902-5335 Public Works Contract
www.Ini.wa.gov/prevailing wage
,$25.00 Filing Fee Required
• This form must be typed or printed in ink, Prol<a Name coon e
• Fill in all blanks or form will be returned for correction (sQL_bEi_ck). CI7 tf D-f 1'P L {I T K ( 10 v p jj171.
• Please allow a minimum of 10 working days for processing. Cuntrazt A,norIngA'<ney(gain army -not neemi or sd.ate)
CilI, n
APPROVED FORM WILL BE MAILED TO THIS ADDRESS Add- f } Z'
Contractor, congany o Iacricy name, addrg,, city, state & ZIP+4
Yl U -N M7°S Co. Y 1:"V Sule LIP+4
AwaNm6 Air-, I'mlecl Cnnmcl PersoP PhoneN
6 S~PIU ~~d c .f)14.sr 44
I, ~ ~ Conmy wn<~<work=i,ne Perm rnwlKm won ..It e<amorm<e
G UnrLEE( W4 I
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old dun dam (aud',I rear wnm,,1 -grand tm-d,y)
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Prune c trecmr has contract.viN the public agency) Co tra I R ® uati N mO Pend to ~ Noomrxrors? Do O int Snd to uZ. na r,
A Idr~~ < CDT ~\kl)flhC106b>~
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C'f(trafl~andoceupatlpn To NOT lizlapmenticc0 Ratcof Rare of hourly rummcd no.
Lary Wnll uoarlyPay Rin,beacon nfwndea
Corn I72 e. addres, ity, star ZIP+4 Indicate total dollar amount
c t~ ry OJ A r( of our contact
1 hereby certify that the above information is correct and that all
d 3 y Gtla , 9~r~ workers I employ on this Public Works Project will be paid no
JPAVIaUShc
/ less than the Prevailing Wa a Rate(s) as determined by the
Industrial Statistician of the admen[ of abor a dowries
Co mm Re is Imo No. ?UI ~ Si tare
w~
Email address return rumba For L&1 Urn Ooy
t ) CMCk Number.__ Amount:
For Idl Urn Only
APPROVED: Department of Labor and Industries tssaw By By
Industrial statistician
After APPROVAL anol n'r My to Awamrne Aeern..
Feb 13 04 03:33p Raymond Moreau 253-473-4012 p.1
APPLE ELECTRIC
Office (253) 305-0233
Fax(253)773-1012
FAX
To: Cite of Yelm Fu: 3604583117
From: Elizabeth ;a. Apple Electric Dole: 2/1320111
Re: Intent to pal pra•ailing wages Pages: 2
AC' Gary Carlson
? Urgent ? For Review ? Please Comment ? Please Reply ? Please Recycle
Notes. Gary, We finally got the Statement of intent to Pay Prevailing Wages in the mail today I
am fazing it to you so you can get a payment on the way for the AM James Company Please call
me if you have am further questions
Thanks,
Elizabeth Garner
Office Manger, Apple Electric
Feb 13 04 03:33p Raymond Moreau 2rq-473-4012 p,2
Departmem.f Latex and fndeaukoi STATEMENT OF INTENT TO
Prevailing Wag. PAY PREVAILING WAGES
(360) 902-5335 w Public Works Contract
www.ltu. wa.gov/Prey ailingw age
$25.60 Filing Fee Re wed
• This form must be typed or printed in ink. Prc;" N." C°voity
• Fill in all blanks or form will be returned for correction ( see back). City Hail ImDYO m t s Ye 1
• Please allow a minimum of 10 working days for processing. c~arsewwi ma Ae~,=y (P„su=.am=y aotfwe9t art,nn:a
"City of Yelm
APPROVED FORM WILL BE MAILED TO THIS ADDRESS Aaa.ci,
Coe,,mmr, company or agency name, address, city, state€Lie+4 105 elm Ave. West
an 1. zle+4
Yelm WA 98597
Apple Electric Awvamg Aa-,cy Pmjm - Phx Phones
P.O. Box 1252 Sall Badoer (360)458-3244
Puyallup. WA 98371 ewmywhem.o3wm Mpeccrd qty wnera waar.;u br peeom.m
'Thurston Yelm
nid due d+K (NNy) D•K mnuan vwa,dctl WIA
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prima contractor (has mmran with thepubleagrney) Contractor Registration No. no wdu.uumbmznors Do you L~.cduuse appmnucm?
Y. ® N. a YC ®No
--AM JAMES CO. ThIC. Rate or Ras of hourly retooled
no.
Craft/trade and occupation (Do60T list i,cmaccs) hourly pay fringe lrmeGU o(wohers
I'
Foreman Electrician 33.02 - t
i
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i
Company c-, adds:a, city, sate, ZIP+4 I (Indicate total dollar amount
22400.00
Apple E1.ectriC_ ow
I hereby ccnify char rite about mforrom on a weed and that all
P.O. Box 1252 wodcn I employ on this Public Works project will be paid no
less than the Prevailing Wage Rate(s) as detennmcd by Jac
Pu a11U WA 98371 Industrial Statistician of the Deponnent of Labat and Indesiney
Contraco P~~USignature
r Registration Re. U0I Tioe
APPLEECO55BR 1 5 Pracid
Email atldmss Pbonc number pw Lsj •mm
la leelectrie2,1m n. ,62 ) - 23- cn~Nerhn. P ?szs or s I pp For td(Use Onl
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Department of Labor and Industries O STATE ENT OF INTENT TO
Pownling Wage PAY PREVAILING WAGES
(360) 902-5335
p
www.lni.wa.govtprevailing wage $25.00 Filing Fee Fee Required
n
• This form must be typed or printed in ink. Project Nal~Ireff 1 Corner,
• Fill in all blanks or form will be rammed for correction (see back). G O I I (p61P 111Pn f5
• Please allow a minimum of 10 working days for processing. cono-a awam:n~ aaency 1®nbpc agency nm eaRal or pdvmel
C.~~ ~F ales
APPROVED FORM WILL BE MAILED TO THIS ADDRESS Aaa ' n ~I
Contractor, company or agency name, address, city, state & ZIP+ q vJ0 y /
oy `J~Ista¢ ZIP - s
yJ~ 9SS97
n rain, Agency P a Conud Person Phone a
C ~LX `CIS . Lcfl~d acl~ (960)M58-
Countywbertr kwill be pe cd C11.here ork"11beperfomred
Horbvsr ~ti~ 9 335 (csrt~~ .I Jrli~
B:ddvedate In'd'y) Dine-nod-roles' (m/d/y)
I I'~ S o3 I~/ ~I o3
Pd/~ ecorArntruato,doocondactwith N/,/Qoblie~ag(ency)C t1 Co/n~tractor Reogistanon NO. .~11gh~DO`yo~u in~mndlnmesunconcamors" Do yeu morn to use apprennew°
--A M R1ayAe$ `O- +J~Jt'I ~]r T~MCIO ~OGJ 0NO Yes ~Wo
Craft/trade and occupation (Do NOT list apprentices) Rate of Rate ofhourly Estimated no.
Heady Pay bar, benefits ofw.darrs
C, -5
/ 37, 90 -
Com any name, addresa, city. stri ZIP+{ T Iof adluatewtaldollar amount $ , 4I 3~rr 0(l•
~1 _ ~QVYse 5 Co our contract c l
n ~x I 1 hereby certify that the above information is correct and that all
.XhJ workers I employ on this Public Works Project will be paid
less than the Prevailing Wage Rate(s) as determined by tno
he
G t f RV w Industrial Statistician oftbe Department of Labor and industries,
CunlractorR snanon No. BI Tltlc Sipes v
U ev d~~l
tit A~cro CGb ~o a S 7 /FUi ^c~ uv
Email address Phone number I Fart IIdw Ob]
i(a5~) 851-SSIvYI ~
Fon l.&I Uae Only C
of Labor and IndusMes _
p ' is l (i JR
1HI(SUNL STHT JHH 11i `i'c+
I !
`6y Indaadal Stan,,.. a,
1:70(1 [trararm n I intent P, pay prevailing wage 219 VI PPROVAI w dwl'le <o A d- A
Canary' esp.
- Lhl
Eno, W'9 Request for Taxpayer Give form to the
(Rev, December 1996) Identification Number and Certification requester. Do NOT
eenanmam of me rremary Send to the IRS.
Ntamei Rwmm srtvlm
namme. Bee apedfio InaWcaona on Page 2.)
Namf e joint account or, you changed your
[yJ ~,1 'I 1 /aus mess name, R dJn Brent from ebo apxMe InaWOness nrame, R EJifBIre1nt Acorn ebo aped a IneWCtlona on Peas 2 ) ve. P* c Check appropratebox: j] IndividuaVSOb proPnetor Coryoration Partnership ? other?----_-_-------------------_----._-
Pddrpjs (num street, and apt. or suite no) Repuesler'e name and address loptional
m ~0,Dk tiff CITY OF YELM
n City, state, and ZIP code (1.)," P.O. BOX 479
w+j~/ YELM WA 98597
-Taxpayer Identification Number IN ust account oumbans) here (opllo„ap
Enter Your TIN in the appropriate box. For
individuals, this is your social security number Social security number
(SSNM. However, if you are a resident alien OR a
sole proprietor, see the instructions on page 2.
For other entities, it is your employer OR For Payees Exempt From Backup
identification number (EIN). If you do not have a Withholding (See the instructions
number, see Now To Get a TIN on page 2. Employer Identification number on page 2.)
Note: if the account is in more than one name, j IL S71 7 Y 3 i
see the chart on page 2 for guidelines on whose
number to enter.
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2 I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding.
Cartification Instructions.-You must cross out item 2 above g you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax realm. For real estate tmnsactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement
arrangement (IRAQ, and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. (See the in mctlons on page )
Sign
Here Signature ? Date ? p. ~.Y -G G~
Purpose of Forrrl--A per who is include interest, dividends, broker and 5. You do not certify your TIN when
required to file an infomla ion return with barter exchange transactions, rents, required. See the Part III Instructions on
the IRS must get your correct taxpayer royalties, nonemployee pay, and certain page 2 for details.
identification number (TIN) to report, for payments from fishing boat operators. Real Certain payees and payments are
example, income paid to you, real estate estate transactions are not subject to exempt from backup withholding. See the
transactions, mortgage interest you paid, backup withholding. Part II instructions and the separate
acquisition or abandonment of secured If you give the requester your correct Instructions for the Requester of Form
property, cancellation of debt, or TIN, make the proper certifications, and W-9.
contributions you made to an IRA report all your taxable interest and
Use Form W-9 to give your correct TIN dividends on your tax return, payments Penalties
to the person requesting it (the requester) you receive will not be subject to backup Failure To Furnish TIN--If you fail to
and, when applicable, to: withholding. Payments you receive will be furnish your correct TIN to a requester, you
1. Certify the TIN you are giving is subject to backup withholding it. are subject to a penalty of $50 for each
correct (or you are waiting for a number to 1. You do not fumish your TIN to the such failure unless your failure is due to
be issued), requester, or reasonable cause and not to willful neglect.
2. Certify you are not subject to backup 2. The IRS tells the requester that you Civil Penalty for False Information With
withholding, or furnished an inocrect TIN, or Respect to Withholi ini if you make a
3. Claim exemption from backup 3. The IRS tells you that you are subject false statement with no reasonable basis
withholding if you are an exempt payee. to backup withholding because you did not that results in no backup withholding, you
Note: If a requester gives you a form other report all your interest and dividends on are subject to a $500 penalty.
than a W-9 to request your TIN, you must your tax return (for reportable interest and Criminal Penalty for Falsifying
use the requesters forth if it is substantially dividends only), or Information.- Willfully falsifying
similar to this Form W-9. 4. You do not certify to the requester certifications or affirmations may subject
What Is Backup Withholding?-Persons that you are not subject to backup you to criminal penalties including fines
making certain payments to you must withholding under 3 above (for reportable and/or imprisonment.
withhold and pay to the IRS 31% of such interest and dividend accounts opened Misuse of Tlli the requester
payments under certain conditions. This is after 1983 only), or discloses or uses TINS In violation of
called "backup withholding." Payments Federal law, the requester may be subject
that may be subject to backup withholding to civil and criminal penalties.
Cat. No, 10231% F. W-9 (Rev. 12-96)
Dcpmsmcnt of Labor and loduseiu STATED.-NT OF INTENT TO
Poevailms Wage _ PAY PREVAILING WAGES
(360) 9OZ-
ww1ni.wa.gwa.gs
w Public Works Contract
ww.l
ov/prevailingwa&e
d
$25.00 Filing Fee Require
• This form must be typed or printed in ink. P.. «s _ canna
• Fill in all blanks or form will be returned for correction (5f& Ack). CI I I Jr p
• Please allow a minimum of 10 working days for processing, c- ...a Aa y (rubtk oar- reaadaa+..~l
4 Iw•
APPROVED FORM WILL BE MAILED TO. THIS ADDRESS.' Adm«y q
Conpvaaor, company aagrnry wn ,addreaa. ciy.srmc&ZIP+4 li,`U,~v
(1./4~1- 1J6irooS CD coy l`PI(A W A q SS91
Q`l_'• ~11yX~ 0 1~ 4v aAOa]'Pmmt3~aa Pmm PMneY ,
`16r~a>r w-A a`i 33-5 ~I (36J)9Sa aye
Gamy wmec wlt hep m ca'(,.~x«v.an wu xe~e
Jf N 1i
-V- 6
aid dacdan (Maly) n m vu n..w d (AMY)
Pd wmcwr(Wam racrwirh+c,ablicagency) Coasracmr Ralianx,o No a
. Do dn stawnoonr DoywimaAwvcavw•m sas7
CD L h J Ya C3 Q Y. ONo
Craft/trade and occupation (Do NOT1ktappw.nslcea) Rmcof Rueofhmvly i Estima¢d no
haudy pay fringe barn of wohers
t Ut~~
i
i
i
I
Compen dd
ou~r~~Y ma, c'y, sure,iu ZlPt4 In of dieam total dollar mnonns $ 3S~L
t~vr ~~o~t I~G o~~nnrr
RR f/.~L I hereby eenlfy that she above infonnauon is correct and that all
pA~fO ( (;IlST workers t employ on this Public Works project will _ be paid no
less than the
rc(s) mrd by the
is p~n r Prevailing Wage Ra
VV rli D /...I Industrial Statistician of the Dcpanmrnt of Labor or and lMusvies.
Co vaeor Re' N UBI Tide si wre
GO- -s Nz-
ci - 6 ue
Grail addreu ne L nwibe/ JO~~ S "POr11FI Vuonl ?
ed lbr nw 0m -J A"' Cnak Nwnbv ? $25 ar $
APPROVED- Department of Labor and Industries Irmml By:
By
lu undal sucisucian
Aner APPROVAL mad smite may to Awardlne Amory_
Jan 23 04 03:45p Raymond Moreau
253-473-4012 p,l
APPLE ELECTRIC
Office (2510,05 V233
P:r, (2:3) 473-4012
FAX
TO. Yclm City Hall Fax: 360-758-3147
From: ElizabethO Apple Electric Date'. 1/23/2007
Re: Pmeaiting wage intent Pages: 2
Alt: Jim Wright
c) Urgerrt ? For Renew ? Please Comment ? Please Reply ? Please Recycle
Notes
Jan 23 04 03:45p Raymond Moreau
253-473-4012
P•2
Dcpanmentof labor andindmasmes STATEMuNT OF INTENT TO
pmvailmg wage = PAY PREVAILING WAGES
(3fi0) 902 5335 . Public works contract
www.lni. wa.gov/pr.ailingwagc
$25.00 Filin Fee Ae wired
• This form must be typed or printed in ink. Prei-K- core+n x
• Fill in all blanks or form will be retomed for correction(cehngk). City Hall Im rovements e m
.plea,,llowa minimum of loworking days for processing. em~ct Awa wg Aamcy(Pb6c agmy tmnelwPdvam) - 1c, -City-of Yelm
APPROVED FORM WILLRE MAILED TO IBIS ADDRESS Add
Convacro,, company or agenty nam4adtlress, city, stale&ZIP+4 105 Yelm Ave. West
Cky Swe ZIP+9
Apple Electric A-e ,As-, ~1t C--Pe- WA 98597
P.O. Box 1252 Sall Bad er (360)458-3244
Puyallup, WA 98371 emmy whee wod: wJlbeP~ramM cmmr whac.eewtmtxno,mrd
Thurston Yelm
eidd.a 'e (mkry) Da,a rovw»r.aw„da (mlvr)
12 OS D3 12 12 03
Prime mntnaor (hes mnmran wdh the twhlie agmry) Conemuer Rcgis[mtion NO. D. mmd.o ,•_subcmaacma? rat-d..
pP rndcu?
Ya ®No ~(No
-AM JAMES CO.
CraNtrade and oceupaliotl (lb NOT Im apprrsticea) Rate of Rug of hourly Eatimamd no.
hcu:ly pay (nogg bmeGts of workers
Foreman Electrician
i
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Com gnome, aW s,city, ZP+4 indieate total dollar amommt
AppxQ E.lec Er3C of onrcorty et $ 22400-00
[ hereby ecrdry Char the above mfomnation is rorzcct and that all
workers I employ on this Publre Works project wip be paid eo
i - less than the Prevailing wage Rate(s) as determined by Oe
PuYall A WA 98371 Indttsmal Statistician of the Deparnnent of Labor and ]ndusvics.
Con«aaor Regictatian No. Old Title si,.l.re
APPLEEC055BR I 601 59
Grail address Phone nmunbcr For Lam uOni
is DDleelectr'1c2 m n. ) - onmr N,uncrr C] 525 or f
For W -
APPROVED: Onf
APPROVED: Department of Labor and Industries lamed Ay`
A..