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STATEPIENT OF CDh4~LIAt~ICE Date: JIA~ 26, 1997 Contract Nu~ber: I, TRACY WRI6HT, ~FICE MANAGER do hereby state: ti) That I pay or supervise the pay~ent of the persons e~ployed by STAT~1 CONSTRIJCTION, I1~. on the ,N CO/5~EM/DEMO, that during the payroll period con encing on the 15 day of ,TlP1E, 1997 and ending the 21 day of JL~, 1997, all persons e~ployed on said project have been paid the full weekly wages earned, that no rebates have been or Hill be ~ade either directly or indirertly to or on behalf of said 5TATON CONSTRUCTION, INC. fro~ the full weekly wages earned by any person and that no deduction5 have been ~ade either directly or indirectly fro~ the full Hages earned by any person, other than per~issible deductions as defined in Regulations, Part 3(~9 CFR Su6title Rf, issued by the 5ecretary of Labor under the Copeland Act, as a~ended !48 Stat. 948.63 5tat. 1@8, 72 Stat. 967; 76 5tat. 357; 40 U.S.C. 276c), and described below: (~) That any payrnlls otherw~ise under this contract required to be sub~itted for the ahove period are correct and co~plete; that the Hage rates for laborers ar ~echanics contained therein are not less than the applicable wage rates contained in any -+age deter~ination incorporated into the contract; that the classifirations set forth therein for each laborer or ~echanic confor~ with the work he perfor~ed. (3) That any apprentices e~ployed in the above period are duly registered in a bona fide apprenticeship progra~ registered xith a 5tate apprentireship agency recognized 6y the Bureau of Apprenticeship and Training, United States Depart~ent of Labor, or if no such recognized agency exists in a 5tate, are registered with the Bureau of Apprenticeship and Training, United States Departient of Labor. 14) That: (a) N~itE FRII~E BENEFITS ARE PAID TD ANPROVED PLANS, FI~IDS, OR PR~RAM5 !)- In addition to the basic hourly -+age rates paid to each laborer or ~echanic listed in the above referenced payroll, pay~ents of fringe benefits as listed in the contract have been or Nill be ~ade to appropriate progra~s for the benefit of such e~ployees, except as noted in 5ection 4lc) beloN. (b) {~RfItE FRIN6E BEI~FIT5 pRE PAID IN CA~I (X) - Earh laborer or ~echanic listed in the above referenced payrall has been paid as indicated on the payroll, an a~ount not less than the su~ of the appli~able basir hourly wage rate plus the a~ount of the required fringe benefits as listed in the contract, except as nuted in Section 4tc) beloN. tr) EXGEPTIOtJS EXCEPTIOP! tCraftl I EXPLAP~TI~1 ~ I ~ MEDICAL IN~JR~JCE i . 56 TO f 1. ;8/HR. IS DEDIICTED ~ I ~PENDII~ ON DE~tJ~IT STATU5. ~ i ~ ~I~ I f2.5~/HR. I5 ~DUCTED ~ i ~ ~ I I ftEMAI~(S ~ I I I ~ AND TITLE I 5IGFh~TUf~~ - ~ TR4~Y NRI6HT, ~FICE M~GER ~ ~ ~ ~ ~ ~ ~'G~~~' ~ L~%c ~" C~ ~ The -+ilful falsification of any of the abnve state~ents ~ay subject the con actar or subcontractor to civil or cri~inal i prosecution. 5ee Section 1Q~1 of Title 18 and 5ectian 231 of Title 31 of the United States Code. I