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,_ STATEMENT OF COMGLIAhGE .~; Date: JUNE 12, 1997 Contr•act Nueber: I, TRAC'f WRIGHT, QFFICE MP.NaGER do hereby state: (11 That I pay or aupervise the payeent of the persons emplayed by STATQN GONSTRUCTION, I~dC. an the MARION CO/SALtM/DE~O, that during the payroll period cooaencing on the 25 day of MAY, 1497 and ending the 31 day of MAY, 1497, all persons eaplayed an said praject have been paid the full weekly wages earned, that no rehates have been or will be aade either directly or indirectly to ar on behalf of 5aid STAT~N COtJSTRUCTION, IhC. fros the full weekly wages ear•ned hy any persan and that no deductians have been eade either dir•ectly or indirectly frue the full wages earned by any per5on, other than peraissible deductians as defined in Aegulations, Part 3 t29 CFA Suhtitle A), issued by the Serretary of Labor under the Copeland Act, as aaended t§8 Stat. 943.63,Stat. 108, 72 5tat. 967; 76 5tat. s57; 40 U.S.C. 276c), and described belaw: tc) That any payrolls otherwise under this contract required ta be. sub'itted for the above pe~iod are correct and co~plete; that the wag~ rates fo~ laborers ar ~echanics contained thet•ein are nat less than the applirable wage rates contained in an1 wage deter~ination incurporated intu the contract; that the cla5sifications set far•th therein fnr each laborer or aechar~ic confor~ with the work he perforied. t's) That any apprentices eeployed in the above period are duly registered in a 6ona fide apprenticeship pragra, registet~ed with a 5tate apprenticeship agency recugnized by the 8ureau of Apprenticeship and Tr~aining, United 5tates Depart~ent af Labor, ar if na such ~ecognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Depart~ent af Labor. i4) That: (a) WHERE FRINGE RE~dEFIT5 ARE PAID TD RPRRUVED PLRNS, FU'VD5, OR PROGRAMS { i- In additiun ta the basic hourly wage rates paid to each laborer or ~echenic listed in the above referenced payr~oll, pay~ents ofi fringe benefits as listed in the c~ntract have been ar will be ~ade to apprapriate pragra~5 for the 6enefit af such e~ployees, except as nntQd in Section 4tc) below. tb7 WHERE FRIN6E AENEFITS ARE RAID IN CASH (X? - Each laborer ar eechanic li5ted in the above referenced payroll has been paid a~ indicated on the payroll, an a~aur+t not less than the sur of the applicable basic hnu~^ly wage rate plus the asount of the required fringe Genefits as listed in the contract, except as nated in Section 4(c) below. tc) E~CEATIC~tdS EXCEGTION (Graft) I EXPLANATION I I I MEDICAL INSLIRANCE I .56 TO f1.58/HR. IS DEDUCTED I I BEPENDIN6 DN DEPENDENT STATUS. I I 1 ~'EPiSIGN I tc.50/HR. I5 DEDUCTED t I I REMARKS ~ ! I I ' NA1+~ AND TITLE I SIGNATURE - i TRAC`/ WRIGHT, ~FFICE MANAGER I `` `'//~~rl~ ~~~~`G~ ~ G The wilful fal5ificatiun of any af the above stateeents 'ay subject the contra~tor or subcontractor to ~ivil or~ criiinal prosecutior. 5ee Section iQNi of Title 18 and Section ^c31 of Title si af the United States Code.