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~ ~TATEI~NT 1~' C~LIAt~E ~ Date: i~4T 1, 1997 Contract Nu~ber: I, fRt~Y ktRIGHT, tIFFICE h~i~i6ER do hereby state: ti) That I pay or supervise the pay~ent af the persons e~ployed by 5TAT~1 I~ISTRl~TION, Ih~. on the h~RION CU/S~EM/DEhpJ, that during the payroll period couencing on the 13 day of JULY, 1997 end ending the 19 day of JL~Y, 1~9i, all persons eeplnyed nn said project have heen paid the full Neekly Mages earned, that no rebates have been ar Mill be iade either directly or indirectly to nr on hehalf of said STATt~I C4N5TRUCTION, I1~. fra~ the full weekly ~ages earned by any persan and that no deductians haae been ~ade either directly nr indirectly fro• the full Nages earned by any person, other than per~issible deductions a~ defined in Reguiations, Part 3 t29 CFR Subtitle A1, issued by the Secretary of Labor under the Copeland Rct, as a~ended t48 5tat. 948.63 Stat. 108, 7~ Stat. 967; 7G Stat. 35~7; 40 IJ.S.C. 276c), and de5cribed below: {~) fhat any payrolls otherwise under this contract required ta be su6~itted for the above period are cnrrect and corplete; thaL the wage rates for laborers or •echanics cuntained therein are not lesa than the applica6le wage rate5 contained in any -,~ge deter~ination incorparated into the contract; that the classifications set farth therein far each laborer or ~echanic cantore with the wark he perfar~ed. i3) lhat any apprentices e~ployed in the above period are duly registered in a bona fide apprenticeship progra~ registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, Ifiited States Depart~ent of Labor, or if nu suct~ recognized agency exi~ts in a StatE, ere registered with the Bureau of Apprenticeship and Training, United States Depart~ent of Labor. (4) 1hat: ta} I,~HE FRII~iE BEP~FI15 Af~ PAiD TU F~RUVED PLANS, FLRVDS, Ok Pft06Rf~5 4)-!n addition ta the basie hourly wage rates paid to each laborer ar ~echanic listed in the above referenred payroll, pay~ents of fringe benefits a5 listed in the contract have been or will be ~ade to appropriate progra~s far the benefit of such e~ployees, except as noted in Section 4tc! below. {bl I+N~RE FkII~E BEP~FI15 At~ PAIb IN CASH iX) - Each laborer ar ~echanic listed in the ahove referenced payroll has been paid as indicated on the payroll, an a~ount not less than the su~ of the applicable 6asic hourly wage rate plus the a~ount of the required fringe benefits as listed in the contract, except as noted in Sertian 4tc) below. !c) E%CEPTIUNS EXCEPTItkV tCraft) I EXAU~ITION I 1~lCi~- INSURt~E 1 .56 TO f1.58/NR. I5 DEDt1CTED I ~ I DEf~NDIN6 DFl DEPEt~NT STATUS. I ~ ~ l I PEt~'iI[IN I f2.50lHR. IS DEDL~TED I ~ ~ I ~ ~ I 1 ti~F1tSS - I h~ F1ND 1I1LE 1 SIi~ITURE ~ 1 TRt~Y WtiIGHT, [~FIt~ ~R I ° I ~ ~ ~. ' ~r~.~,a ~, ~i~;~ ~ , The Nilful falsification of any of the ahove state~ents ~ay subject the cont~Gtar or subco6~~actor to civil or cri~inal prosecution. See Section 1M1 af Title 18 and 5ection 23I of Title 31 of the United States Code.