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STATEMENT OF COMPL I RlJI:E Date: ALIGUST 21, 1947 `-.-~ Cantract Nuvber: I, TRAC'~ WRIGHT, OFFICE MFINAGER do hereby state; ~, (i) That I pay or sup~rvise the payeent of the persons esployed 6y STATDN t~NSTktlCTIOt~, INC. on the MARI~N CU/SALtM/DE:ritl, that during fhe payroll period coseencing un t~e 10 day of AUGUST, 1997 and ending the 16 da~ of Al~it15T, 19?7, all persans e~ploy~d on said project have been paid the full weekly wages earned, that no rebates have been ar will be aade either directly ar indirectly to or on behalf af sai~i STpT4N CONSTRLICTIDN, I{VC. froe the fu11 weekly Hages earned by any person and that na deductior~s have been sade either directly or indirectly fro~ the full Hages earned by any persan, other than per~issi5le deductions as defined in Regulatians, Part 3 iP9 CFR Subtitle A), issued by ttie Secretary af Labor under the Capeland Act, as a~ended t48 Stat. 948.os' Stat. i@8, 7~ Stat. 467; 7E Stat. s57; 4~ U.5.C. P7bc), and described below: i^c) That an1 payroils other~aise under this contract required to be subaitted fur the above period are correct and coaplete; that the wage rates far laborers or ~echanics contained therein are not less than the applicabl~ wage rate5 contained in any wage deterlination incorporated into the cantract; that the classifications set farth therein for each labarer or aechanic confuri Hith the Nork he perforved. t3) lhat any apprentices eeplayed in the above periud are duly registered in a bona fide apprenticeship pragra~ registered with a State apprenticeship agency recoonized by the Bureau of Apprenticeship and Training, United States Departeent of Labor, or if no such recognized agency exists in a State, are registered with the Bureau af Apprenticeship and Training, United 5tates Depart~ent af La6nr. {4l That: ta} WNERE FRINGE RENffI1S AkE PAID TU RPRROVED RLAWS, FUNDS, Ok pRpGFtRPfS t)- Fn addition to the ~a5i~ hourly wage rates paid tn each laborer or iechanic listed in the ahove referenred payroll, pay~ents of fringe benefit~ as listed in the contract have been or Hill be ~ade to apgropriate pragra~s for the benefit uf surh e~plflyees, except a~ no#ed in Sectian 4{c) 6elaw. {b) i,~iERE FRIt~[;E R~I7S ARE F~AID IN CASN {~f - Each laborer or ~echanic li~ted in the above referenced payrnll has been paid as indicated on the payrall, an aeaunt nat less than the sua of the applicable basic hourly wage rate pl~~s the aiount af the required fringe benefits as listed in the contract, except as noted in Section 4tc) below. ~c? EXCEATIOiVS EIiCEATIUN {Craftl I EXRLAIVflTIQN I I+~7lICF1L IiV5URANCE i .5b TD f2.58/HR. IS DEpUCTED ~ ~EPEidDIN6 ON DEPENDENT STATL~. 1 f~IVSIUN I #2.5~/HR. IS OEDUCTED REMAEiK5 i n~t HNll ilTLE I S16NA I TRACY WRIGHT, ~FICE Mt~yAGER ~ . I ~ ~ I The Ni!ful falsificatinn of any of the above statesents ~ay su6j t the c ractor or su~co 3Ct0Y' tD CiViI or cri~inal I prosecution. 5ee 5ectian 10Q+1 of Title 18 and Sectinn 2s'1 af Title 31 of the United States Code.