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STATED3EIJT LF LbiMGLIA~dCE Date: AUGUST 21, 1997 Contract Nueber: I, TRACY WRIGHT, tIFFICE MANAGER do hereby state: (1) That I pay or supervise the payeent of the persons eeployed by STATDN CUNSTRUCTIO~J, I~~C. on the Mc~^'''N C1)/SALEM/DEiIU, that d~~ring ti,e pa~roll period coaaencing on the ~7 da~ of JUL'!, 1997 and ending the ~ d-ay of F , 1?9i, all per~:ons e~ployed on :aid pro.ject have been paid the fuli weekly wages earned, that no rebates have been or wil~be eade either directly or indirectly to or on behalf of said STA70rd COtJSTRUCTION, I~dC. froa the full weekly wages earned by any person and that no deductions have been e~de either directly or indi;~ertly fro~ the full Hd9e5 earned by any person, other than pers]SS1bIP deductions as defined in Regulations, Part 3 fc9 CFR Subtitle A), issued by the Secretar~ of Labor under the Copeland Act, as aaended !4B Stat. 948.03 Stat. 108, 72 5tat. 967; 76 Stat. 3~7; 40 U.S.C. 276c1, and de~cribed below: fc) Thc~, dr~~ pajrolls otherwi;~ under tr~is contract requiretl to bY su6~itted ior the above period are corr,ec+ and coaGlete; that the waqe rates for labo:ers or sechanics conteined ther~ein are not less than the applicable Nage rates contained ir~ any wane deter~inatiur~ incor~pr,rated into the contr~ect; that the ~la5sific:.tions set forth therein for• each IdbGl"FY or eechanic contor~ with the r~~rk he pei~for~ed. (3) That any aFprentices eeployed in the abave period are duly r•egistered in a bona fide apprenticeship proqrae reyistered with e State apprentie~s~ip agency recog~ized by the Aureau of Appr~er~ticeship and Tr~aining, United States Depar~t~ent uf Lebor, or• if nu such recognized agenc~ exist: in a State, ar~e registered r~ith the Aureau of Apprenticeship and Tr•aining, United States Depa~^tment of Labor. (4) That: !a) WF+~P,E rP.ItdGc AEtdE~IT5 AkE RAID TU Af-'F'RUVED RLAt~, FUN-S~ OR PRC~RAMS ~)- In addition to tt~e 5d51C ri~~lrlj wage rates paid to eac~ labo~~er ar aechanic listed in the atave referenced pa,roll, pay~ents o~ fringe benefits as listed in the cor~tract ha~~e been or will he ecde to apprupriate p;~ogra~s fu~ the henefit of such eaployees, except as noted in Seetian 4tc) helow. ° ibl WHERE FRIN6~ AE;dEFITS AkE PAID IN CA,SH !X) - Eacfi laborer or eechanic listed in the above referenced payroll has been paid a~ indicated on the payroll, an aeaunt nut less than the sua of the applicable basic hourly wage rate plus the aaount af the req~lired fringe bene`its as li~ted in the contr~act, exceat as nated in 5ection 4tc) below. tc) EXCJ~TIOtJS EXCr~TIUt~ tCraftl I EXPL~dATI~J i ~ ~tEDICAL IN.~.IRANCE I .5b TO 51.58/NR. IS Dmt1CTED ~ UEPQJDI~dG ON DEPENDENT STATUS. ~ I ~ PEtd5ID!~ I 5~.5~A/HR. IS DEDUCTED ~ ~ I ftt~SARKS NFlPit AND T I TLE TRACY WRI6'FIT, aFFiL'E MANA6ER SI ~~~~C ~ ~~~~~C~X~~` The Hilful falsification af any of the above state~ents ~ay sub.~ect the co actor or su ntractor to civil or cri~inal ~osec~~tion. See Section 1~1 of Title IB and Section 231 of Title 31 of the United States Code.