Okaloosa County BOCC — May 15, 2013 — CW Roberts Certified Payroll — reading text

560371 STATEMENT OF COMPLIANCE “tepall BS |. SHARON MACKEY (1) Thal pay or supervise the’ payment of tha persons employed (building or work) NWERA Rehab of Publis Paking thal during the payroll period 14/19/12 = | 11/2542 _ all _ persons employed on sald project have been paid the ful waskyy wages eamed, thei no rehaies have been or wil “be mais sither rectly or Indirectly (© of on behalf of sald (Contractor or Subcontractor) C. W, Rober Contracting, Inc from the full weekly wages eamed by any person, and that no deductions have been made either diractly or Indirectly from tha ful wages eamed by any parson, other than permissible deductions @a defined in Regulations Part 3 (29 CFR Subiile A), issued ty Secretary of Labor under the Copeland 3145), and described below: \EEQ OFFICER do hereby state: by C. W. Roberts Contracting, Inc onthe Acl, a5 amended (48 Stat 48:63 Stat 108;72 Stal. 987; 76 Stal. 387,40 U.S. Loan #4 ~_tife_~ AFLAC Chit Supp #1 Uniforms ._-Overpayment "_, AFLAC Cancer Fortis Dent! ‘AFLAG- Dental idvanas. “AFLAC - Hosp ~~. AFLAG- STS." “AFLAC Ah CWE Hh -F- OWe TREC Hin ES- CWR IK CW Tosn #4 Misc. required to be submitted fer the above period aro comact and compleia; therin ara not fess than tha applicable waga rates contained in any (2) That any payroile otherwise under this contract lassificstion sel forth for each laborer ar mechanic conferm with ‘That the wage rates for laborers end mechanles contained wage determination Incorporeted into he contract; that the ths work performed fide apprenticeship program _raglalered Department of ” Labor, (9) That any apprentices eniployed Inthe above period are duly registered in a bona United States wih Siale ‘enprentceship agency recognized by tha Bureau of Apprenticeship and Training, United States ar ff ia auch recognized agency exists In @ Stale, ore registered wih the Bureau of Apprenticeship end’ Traintng, Deparment of Labor, (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS or mechanic fisted in the above referenced In addition to tha basla hourly wage ratas pald (0 each taborer be made to approplate payrall, payments of fringe banalits as listed Im the conlracl have been or wit programs for the bereft of such employees, except aa noled in Sedlon 4 (a) below. (b} WHERE FRINGE BENEFIT? ARE PAID IN CASH Each laborer or mechanfe sted In the above referenced payroll as paid, as indicated on the pay an emout nol teas then tha aum of the apolieable basle hourly rate plus the amout of tha required ‘nga benefiis as sted In the contract, excopl as noted In Soctlon 4 (c) bataw, fe) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION NO WORK WEEK Remarks : NAME AND TITLE SIGNATURE SHARON DMCKEY —, SEO. OFMGER Mendy l i THE WILLFUIL FALSIFIGATION OF ANY OF THE ABOVE STATEMENTS MAY SUBUECT THE coNTRACIOR OR 8 geonreacroR 70 CIMIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 1a AND SECTION 281 OF TITLE 31 OF THE UNITED STATES CODE 56272 Page - 8 ©. , Roberts Construction bate + aafag/aa Certified Payroll Repart w/Fringe Info Peviod and - 11/25/12 Gum, Roberta Contracting, Ine. Period le. 06 3372 Capital’ Circle NE ‘TallahasserL 32308 ob Wo. tstina NHFRA Rehab of Public Parking Okaleowa Co. BOCC Sou.see.Na FHS Gep § Cat Mn Crate step - Regier, +. . ovesting . . Other Total goby. +. hack Detail... « Name/Rddrese wrk Bate Hours Rate -Houre Rate xe, Hours © Amount. © Daterdpklon Amount No WoRK eaRroRED fy *8b (building or work) NWFRA Rehab of Public Perkl that during the payroll perlod 41/2812 - 121212 all persons employed on Saki project have been pald the full weekly wages camed, that no rabales hava been or wil be made alther directly or Indirectly to or an behalf of aakF (Contactor or Subcontractor) C. W. Roberts Contracting, Inc from the full weekly wages oamed than permissible’ deductions ag dafned in Regulalons Part 3 (23 CFR Subtle A), lesuad by Sacretory af Labor under the Copeland and described below: Ack as amended (43 Stal 948;83 Stat 108: 72 Stal. 987:78 Stat, 867;40 U.S.C. 3148), Loan #4 wtf = AFLAC |, Chid Supp #1 Uniforms Overpayment | AFLAC Cancer _Forls-Danl FLAC Hata —“Favare FLAC Roap— —APTAC- STO APA CHIE CWE —___,_FIN= FCW SEC CWR_, Pith ES OW AOTC To toar Ft TES Undar this contract requked to be submitted forthe above period are correct acd complete; and mechanks | canlained therin are nat fess than the applicable wage rates contained In any (2) That any paymiis othorwise that the ciasslication ast forth for each aborer or mechanle conform That the wage rates for laborers wage determination incorporated thin the contrat the work performed employed In the above ered ara duly regfelered in @ bons fide appranliveshin progam registered ‘of Apprenticeship end Training, United States Department of Labor, (3) That any spprenticos of Appronticaship and Training, United Stslos a Slate apprenticeshlp ageney ratognized by the Bureau or if na such recognized agency exista in a Slate, are ragistered with the Bureau Department of Labor. (4) Thet: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLAN, FUNDS, OR PROGRAMS [>] ia ouston to the baxio hour, waga raloe pal to each laborer or mechan tslad tho above _caferonead paytolh payments of finge benafte aa fied In the contact hava baon' or wll be made to appropiate progres fot tho benefit of such amployeas, except as noted’ In Seclion 4 (c) below. (>) WHERE FRINGE BENEFITS ARE PAID IN CASH Each faborer of mechanic sted in the above referenced payroll has paki, as indicated on the payroll, an amout rot less than the sum of the applicable basic hourly rata plua the amout of tha required fringa benefits as sted in the contract, axcep! as aoled in Section 4 (c) below, (¢) EXCEPTIONS (ORAFT) EXCEPTION EXPLANATION NOWORK Remarks: NAME AND TITLE SIGNATURE EEO OFFICER SHARON MACKEY =, TR WILL EALSICATION OF ANY OF THE ABOVE STATENENTS VAY GUBUECT THE CowrRAGrOR on(JUacoNMAGTOR TO GML oR IIL EAST 2 IS QDOVE STATEMENTS. AY sum Te cevhacron ox( Humor ro 56272 CLM. Robarts Contracting, Ine. 9372 Capital Circle NE ‘TallahasserL 32308 goe.Sec.No FMS Dep § cat Mn Craft step Nonte/addreas rk pave c. W. Robexts Conakzuation Gertitied Bayzoll Report w/Pringe Into Tob Ko. asiia4s WWeRA Rehab oF Public Parking Ukaloose Co, Roce = + Regular... . overtine Hous Rete ours Rate HO WORK PERFORMED «| + other Kea. otal Bours Page - 35 Dake + aa/i3/12 Period Bnd - 12/02/12 Poriad No. + a gob Amount —Deacription + check Datatl. ‘aroun -Pringe Beneits. STATEMENT OF COMPLIANCE 666371 P (231 |, SHARON MACKEY \EEO OFFICER do herby state: Ing onthe (1) That | pay or supervise the payment (ouitding or work) NWFRA Rehab of Puble Parkin that during the payroll period said project have been pald the ful ‘week wages earned, thal no to or on behalf of seid (Contactor ar Subcontector) CG. W. Raberis Contacting, {nc fram tha full weekly ages eamed by any person, and that no dedustlons hava been made elther directly or Indirectly from the full wagea eamed by any parson, han permissible deductions as defined In Regulations Pat 3 (29 CFR Subille A), issued by Sscretary of Labor “under the Copeland 108:72 Stat, 987; 76 Stat, 35740 U.S.C, 3145}, and dosorleed below: of tha parsons employed by C. W. Roberts Contrasting, 12912-42192 jell persons employed on Yebatos have been or will ba made etter altectly or Indleclly other Act, a9 amended (48 Slat, 940:63 Stat, Loan #4 tifa AELAG |, Gilt Supp#1_ Unifoms 2 Overpayment. AFLAG-CancarFortlg-Dent!___ FLAC Dental, Ravanice. AFLAC Hogp PLAC BT AFLAC. THIRTES OW THINS CWE FT EC- CNR AM ES OW AOTC nea FT ra (2) Thet any payrolls * olherwise under thls contract requfed to be submitied for the above period are coment and complete; That the wage rates for faborers and mechantes contained therin_ are not less than the applcabla wage ratas conlened in any wage determination incorporated Into the contract; that the classification set forth for each iabarer or machanle conform with the work performed (3) That any apprentices employed In the above period ars duly registered In a bona fds apprenticeship program ragstered with a State “apprenticeship agency recognized by the Bureau of Apprerticaship and Training, United Stafas Department af Labor, ari no such recognized agency exits In a Slate, are registered wth the Bureau of Appronteaship and Tralning, United Staton Deparment of Labor, (4) Tha FUNDS, OR PROGRAMS [2] 1 asation to the boslo hour wage rae pold to aoh laborer or mechan stud nthe above | efranced payral, payments of ffige benefts as Isted in tha contact fave bean” ar wil -be made 1 appropiate programe for tha ‘banaf of such employees, except as noted” In Secon 4 (c) below. wat: (2) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each taborer or mechanic tated in the above referenced payroll has pak, as Indicated on the payroll, an amout not fess then the sum of tha applicable baslo hourly rate plus the amout of the requlied finge benefits 25 sted in the contract, except as scted In Seoton 4 (c) below. (0) EXCEPTIONS (GRAFT) EXCEPTION EXPLANATION NOWORK Remarks: A NAME AND TITLE SIGNATURE SHARON MACKEY » BEO OFFICER oR sueeeracron TO CIVIL OR THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE GONTRAGTC ES CODE, CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SEGTION 291 OF TITLE 31 OF THE ‘UNITED STI 6372 Page : ” ©. W. Roberta Construction Date = aayar/az Carticied Payroll Report w/Pringe Into Pariod end - 12/09/22 Com, Roberts Contracting, Ic. Period No, - a6 3372 Capital Circle Ne Tallehaspeyl, 32308 Job No. asia. wigan Rehab of Public Parking Okalaoea Co. BOC Sov.Sec.No FHS Dap 8 Cat Ha Craft step + + Regular. . .. , Overtime . . Other Total Job. + + + Check Mevait. . Nane/Addrens irk Pate Hours uate Hours = Rata Hire, Hours Amount. © “Degoriptien Aram WO WORK PERFORMED STATEMENT OF COMPLIANCE sooo Rusa ep nl “EEO OFFICER do hereby state: |, SHARON MACKEY (1) That 1 pay or supervise the payment of the persona empioyed by C. W. Roberts Contracting, | Ino on ths fouling or wark) NUVFRA Rehab of Puble Parkin thet during the payroll pertod ‘2Hon2 12/1642 all parsons employed on said project have been pald the full weoky wages earned, that no rebates have been of wil be made elther directly or Indirectly ino fom the ful waakly wages samed behalf of sali (Contractor or Subconvacior) C, W. Roberts Cantracthg, deductions have been made siher drectly or Indirectly ftom the Reguons Ped 9 (20 CFR Subtitle A), Issued by Secretary of Labor 108; 72 Slat 867; 76 Stal. 367:40 U.S.C, 9148), and desorbed _ below: full weges eamed by any person, other or on under the Copeland by any person, and that no than permissible’ deductions a8 defined Act, a3 amended (43 Stat. 948:63 Stat Loan #4 life = AFLAC. Chis Supp #1. Uniforme + Overpayment. AFLAC-Cencer__,_Fortle-Dant!__ FLAT ~ cae 1 POVEnee. 7 AFTAU- Hosp. TA AFTAC ST APLAR LNA ECW on =F -CWR isons TIRES OWR 401 ON ean ET PL (2) That any payralls otherwise under this contract required fo ba submitted for the above period are conect and ompleta; That’ the wage rates for laorera and mechenies contained therin are ot igs then the applicable wage rates contained | any wage determination incorporated Into the contact; thatthe claseiication set forth fer each faborar or mechanic conform with tha work parformed (3) That eny apprenticas employed In the above period are duly registered in with @ Slate apprenticeship agency recognized by ths Bureau of Apprenizeship and Training, ar if no such recognized agency exists In a State, are registered with the Hureau of Apprenliceship and Training, Department of Labor. 8 bona fide apprenticeship progrem registered United’ States Oepariment of " Labor, United” States (4) Thats (@) WHERE FRINGE BENEFITS ARE PAID YO APPROVED PLANS, FUNDS, zal in addon to the baste hourly wage rates paki to each