Fillable Printable 700-143-000

700-143-000

F700-143-000 Affidavit Addendum B 05-08 DO NOT SEPARATE FORMS PRIOR TO APPROVAL BY L&I

(Original copies must be submitted-copies will be retained by L&I after

approval.)

Department of Labor and Industries

Prevailing Wage

(360) 902-5335

www.lni.wa.gov/TradesLicensing/PrevWage

•This form must be typed or printed in ink.

Affidavit of Wages Paid

Addendum B

List of Next Tier Subcontractors

Public Works Contract

No Additional Filing Fee Required

(Please staple this addendum to the corresponding Affidavit of Wages Paid form.)

Project Name Contract Number

Company Name Title Signature

UBI Number Contractor Registration Number Contract Awarding Agency (Public agency – not federal or private)

List all Subcontractors your firm hired for this project.

Subcontractor’s

Business Name

Subcontractor’s

UBI Number

Subcontractor’s

Contractor Registration Number

Subcontractor’s

Phone Number

For L&I Use Only

APPROVED:Department of Labor and Industries

By ______________________________________________

Industrial Stastician

NOTE: Each and every contractor and

subcontractor must file an Addendum B form

with their Affidavit if any subcontractors

were hired by their firm to perform work on a

public works project.

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