LABOR COMPLIANCE PROGRAM ANNUAL REPORT

1 LABORCOMPLIANCEPROGRAMANNUALREPORTS uggestedFormat/orAwardingBodvthatenforce sitsownLaharComplianceProgram/orallproje ctsILahorCodr (3))Reportforthereportingperiod07/01/201 0to06/30/20II(mm/ddlyyyy)(mmiddlyyyy) (LCP) :July22, (assignedbyD1R) (includename,title,address,telephone,fax ,ande-mail,ifavailable):BobMacauley, ,CA91723(626)974-7600x2126 Office(626) IY'lYESIfYes,proceed10item6 onthenextpageDNOIfNo,completetheinformat ionbelow,signthefonnandsubmittoDIR, ,455 GoldenGateAvenue,10thFloor,SanFranciscoC A94102 WhatsuggestionsdoyouhavefortheDepartment ofIndustrialRelationstobetterassistyouwi thyourprograminthecomingyear?(attachaddi tionalsheetsifnecessary)Pleasemakethisfo rmINTERACTIVE liketheDAS-140formsoit :~~'\ ,LaborComplianceOmerAugust29,2011\Signat ureNameandTitleDate\ (provideallinfonnationrequested,attachin gasmanysheetsasnecessary).

2 2 StoryModular(6)ClassroomsBldgBidAdvertis ementDate10117/08-Bid#08-09-10901/29110 - Bid#09-10-10203119110 - Bid#09-10-103 PrimeContractorSilverCreekIndustriesSilv erCreekIndustriesSimplexGrinellContractA mount$2,156, $2,156, (a), 2 StoryModular(6)ClassroomsBIdAffectedCont ractorAmountAmountApprovalofForfeitureID escriptionof(whodirectlyemployedtheAsses sedRecoveredRequestedfromLaborViolationw orkerCommissioner?AlternativeFireProtect ion$ $ 2 StoryModular(6)ClassroomsBldgProTecMecha nical$ $ $ $ forwhichapprovalofforfeiturenotrequested fromtheLaborCommissioner, 2 StoryModular$ $ (6) 2 StoryModular$ $ (6) $ $ forwhichapprovalofforfeiturewasrequested fromtheLaborCommissioner,pleaseprovideth efollowing:ProjectNameAmonntAssessedAmou ntRecoveredLC 1776(g)LC 1775LC 1813 WagesTotalLC 1776(g)LC 1775LC 1813 # :DYES0 NOIfyes,identilYaffectedcontractor(s)ors ubcontractor(s)anddate(s) (DAS)?)

3 Pleasecheckone'DYES0 NOIfyes,identilYaffectedcontractor(s)ors ubcontractor(s)anddate(s)ofreferral:0394 708993C,m"",COVINAVALLEYUNIFIEDSCHLDIS~I ~~f~..''r!..0:::;:ii~=O~co~~..m~0:$;;O~c o~=m~ ~ ;;1"~ImO~~DUde,~1519[.00 :htI-owr,flJIb&D::~'l.,,!!,i,htS8!lnjI\ "d'"Tube ~",1D1511"WFed'""mOvem;,htEan__buai' '' $~~:.~!.~ ::;=::~=r",,_D"d'"p,,,"DFed'" 'BoxfedEleLorgePtk,andFedExSlU" "l1dG1'BSI'!!I\ ,..4bExpressFreightServiceor=~l!.a1r,~~0 ~~:;~~~~""""""" ~"'McnloVunl8aSATURDAYD eliwryilJll' :5 PlIcIcagingDFed'"Envelope* ~~~~~ht0~~=:,~gvemight=:'-~y=::'= ~~~~_.~~~"' ;;:~ ::F8dE: :Ilne-!xuld""'. ~::~'7::.~:~~~=~=IuGU:::'::~=~mf'IlIO"~~ 'Part'15827M1994-2tOIfeOE>:<f' "" , ~EMerrlllbAccLNLllfrndilClnlNLIIIIuw.~oS ender0 Recipient0 ThirdParty0 CreditCard0 ;gnatllreDRequired~=:':"lI9lIbnfor:::t.]

4 , ~~ :-v0~t~=r.,0~~=onfedExSlnllrO0 lI:1d"NOTA vailablefurAvailllbleONLYfor=.~~Frei~htE xpro"FedExFQtllwrn9t-==~"1::=".."'--=--c ,--== " "DV"DD~I"AlJI'I'IIlIdled,StiIJllll". ,~l845 Sh""",(. ~' :luca'lgdlyic:. 'lI' ~ ~-5059~P91723-28031882-7731-4 Phon,(626)974-7000.)1'StateCA'''~:.~8 6 8 2"'umberSender' ,te8/30/11 Sender'sN,m, >Recipient's4 5 Add"..5 GoldenGateAve,10thFJoarWe nllOtHhtlrlO1', ' "..519 EBADILLOSTcnvSanFranciscoStateCAZIPQLdO? AddressTorequutl"" ,""" ~ .c",COVINAComPanyAttn:LCPS pecialAssistant3lo"".;,,,,,DIROff' , 'Phonej~~=~~~87 qj200~f Ifp~~t