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

correct and complete; (hat the wage rates for laborers or mechanies containad therein are not Mary Ann Scurlock | W7 Akg Cran 9 couclet| less than the applicable wage rates contained in any wage determination Incorporated into the contract: THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE that the classifications set forth therein for esch laborer or mechenfc conform with the wark he perfermed. STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE! (3) That any apprentices employed in ihe above perlad are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Depariment of Labor, ar If no such recognized agency exists inva Stata, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a), WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. n addon to the basfe hourly wage rates paid to each laborer or mechanle fisted Ih the above referenced payrol, payments of ings benefits as listed In the contract have been or will be mad to appropriate programs for the benef of such employees, except as noted in Secon 4(¢} below. (0) WHERE FRINGE BENEFITS ARE PAID IN GASH [x 7 Jesch laborer or mechanic ised in the above referenced payroll has been ald, as Indleated an the payrot, an smount not ess than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benertts as lsted in the contract, excepl as noted In Section 4(c} below wrod? Wage and Hour Record: Contractor's Nama For Was Enog Detonibiras 20 Prejact an Location TW FE Regional Apr rona10.89 Constucton tant Payrolt Numba Ga oF m 8 eductions (10) eaplajte Sam a east (@)_Deduct total fom and 4 Digit (eantiner Hours Gross Medicare Total rom Fringe Benefit (@-aligie 35 and tall nde WWoskiy Deduction Sheet roquired on contraata Let 42) Grose Sheet fatiached) prior fo 10108) | Exeraptioné/ (attached) Reco & Gender jwiina W. Taylor | ene 0.09 #YALUEL XK AKIO whttetala 0.00 Ryan Grey to 0.00 AVALUE! XK D827 wmetala 2.00 fetinon Golden Se. 0.00 AVALUEL Pe aon.r42 Whttotale 0.90 fora Tasior 89. oa 9,00, Lexx.nx.7268 whitettale 9.90 Marte! Gipson 2 0.00 2.90 xxx -xKs607 lackiNile 9.00 featur Baringer 4 2.09 2.00 xxx 9640 whiteMale 9.00 facotty Davis as 0.00 bxxxxxait1 wonejiala 00 [doseph Bh, dr $1 0.00 2.00 Lxexxa04e Whltedbata 9.00 [Auatin witingion $0 9.00 2,00 Lexx-xrrees wterala 0.00 ay Thiet 20 0.00 9,00 xxx cxx36 WhiterMalo 0.00 [vasan Leatherwood M2 1,00 0.00, ox rcK687 Whitettate 0.00 _| STATEMENT OF COMPLIANCE Pate = 4/10/13 566373 Bupal 4! “() ‘That I pay ox supervise the payment of the persona employed by C. ¥, Roberts Contracting, Inc (oullding or work) NWFRA Rehab of Public Parking Okaloosa co, BOCC Thee during the payrolt period 12/33/12 - Ga/oB/a8 ; aL) persons employed on said projact nave been paid the full weekly wages earned, that ao rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or tor) c. q. Roberts Contrasting, Tne fron tha fll weekly vages eared by any person, and that no deductions hove boon nade either dizecriy or inairectiy fron the full wages earned by person, othar than permissible deductions es defined in Regulations Part (29 CFR Subtitle Al, issued by Secratary of Labor under the Copeland Act, as amended (49 Sat. 940763 Stat. 00:72 stat. 967:76 Stak, 357:40 U.6.c 3245), and described helo: Doan #2 life - AFLAC, Child supp#l , Oniforns , Overpayment —, AFLAC-Cander , Fortis-Dentl APLAC-Dental | Advance ; AFLAG-Hosp || ARLAG-S7D > APEAC PHIER-B-CWR =| HUth-F-CuR Hith-w¢-CWR ©; HItH-ES-CNR =, 401K CHR «Loan #1 + Mie : (2) ‘hat any payrolls otherwise under this contract required to be submitted for the above period axe coxxect and completes That the wage rates for laborers and mechanics contained therein are not lese than the applicable wage rates contained in any wage detexmination incorporated into the contract; that the classification set forth fox each laborar or mechanic conform with the work performed (3) ‘That any appxentices employed in the abova period ara duly registered in a hona fide apprenticeship progzan xegiatered with a State apprenticeship ageacy recognized by the Bureau of Apprenticeship and Training, United States Department of hahor, or if no such recognized agency exiate ia a State, axe registered with the Bureau of Apprenticeahip and Training, United States Department of Labor, (a) Thats fa) oe FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS [¥] In addition to the basic hourly wage rates paid to each laboxer or mechanic listed in the shove referenced s-7- payroll, payments of fringe benefits as listed in the contract have heen ar will be nade to appropriate Programs for the benefit of such employses, except as noted in section 4(s) below, ‘* SEE ATTACHED BENEPTT SUBET +* (b) WHERE TRINGE BENEFTTS ARE PAID IN CASH | zach laborer or mechanic Listed in the above referenced payroll has been paid, as indicated on the payxoll, +" an amount not less than the aun of the applicable basic hourly rate plua the amount of the required fringe benefite aa listed in the contract, except na noted in Section’(c) below. fc) mxcuprrons (CRAFT) EXCEPTION EXPLANATION Remake: SIGNATURE (850 OFFICER Levin dh je ‘THE WILLPUL FALSIFICATION OF ANY OF THE AROVE STATEENTS WAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION, SHR SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES cops. NAME AND I'L SHARON MACKEY sen72 e.1, Roberts Contyacting, Ta. 3372 Capital cixole wm Tadlahanner” 37308 fog.dec.8to FMS Dep cat wm craft Btep Name/Address Wek Date M008 01 3230 niyoe/as RO-MCOLss 8 Bougles V. Ademe surveyor ©. W. Roberts construstien Coxtieied Payroll Report /Pzinga info 08 No.1 AsaLoaa miron Rehab of Publis Parking Okatensa co. ROE +. Regular. Rate Hours woure vale mbiva (Wot of sspante ‘Adama, Douglas V, 2.00 mKETE29 MF 003 D2 3093 Terbra F, Beasley os/os/i3 3,00 | 43,000 quatdey contre! Technician 3.00 Pemale white {Not of Hispanic Bessley, Tanbra 7. OE3217 MLA 03 2 ao Onrinvopher 8. Davie oaoasaa 8,00 22,500 supertotendent 0.00 Wale white (Mot of Hlepania Tavis, christopher a. HOE-KEBOAT MF O08 OL SD onyassaa ELizsberh &. Gabld oayas/a3 22.000 az.000 19.00 30.00 . overtime . pate Page - 7 pase = Muo/a3 Period md - 01/06/13 Period No, = 4 . Other Total mb. Ure. Hours Anu ‘Daseription 2.00 $2.50 Gross Pay 2.00 «82.50 FED mnsewe ED PICA ¥/n eo Medicare HLeh-P-00e Met Fay ane 82.80 2,00 82,50 2.00 39.00 Gross Pay 3.00 39.00 FRD Incoma T ED FTCA w/h on Meainare unitors Mee Wet Poy 3.00 (38.00 ao 39.00 2.00 ag0.00 Grose Fay 8.00 180,00 FED Income 7 Fan YER ¥/h FED Medicare HLtKeF-cHe APEAC-87D 402K CHR RTH he A0LKR OF Net Pay 10.00 220.00 io.en 120.09 Grogs ray = Check Detail... ‘Amount: 93790 1,080.00 sae 60.04 alas 98.00 reray aavon2 2137.80 156.77 as ae.72 2.00 az9.62 erry e210 4,075.00 98.68 60.76 aera 95,00 7134 6.00 18.00 43.08 ese2a 336.00 36372 4.9, Roberts Contracting, Ine. 3304 Capteal circle we TaLlahaxecrs, 22300, Soc,Sec,No MS Rep B Cat tn Yana /Addxesa ©. W. Robarte Constmction Coxtitiod Payroll Report w/Pringe Tato oa Ho. Asi4oat MURA Rehab of Publie Parking Okaloosa co. Boct = other re. ovaxtina . wours Rake crart step rk Data +s Regular. Mora Rate Page - 38 Date = a/ua/aa Peried and - 63/08/13 Pezkod Wo. ~ a8 Cosertption FED Inceme 7 Uhexilied taborer {Geneva} 29.00 240.00 THD FIA s/h ED Medicare Fenale tite fot of Rlepanto yet ray 20.40 20.00 240,00 Geils, Eifsabath 1. 20.00 30.00 240.00 MiKaK-1602 MH 003 OL 3084 larsy &, Hortta a/t4A3 ay 2,00 13.000 2.00 25.00 rose Pay ‘Sciteuy 0" motrunent person 2.00 2.00 25.00 FEO Znoone T FED FICA w/h Yap Healeava ATLAG-s79 vale Miike (Wot of HLspante mot Say too 28,00 Martin, taney &. 2.00 2,00 38.00 ouemesss0 BH eUT 02 2062 David 2. Norman ayers . 6.00 19.500 4.00 15.750 8,00 105.06 exoap Pay Durp truck Driver 00 ery $00 395.00 SED socone ‘FEO FICA w/h PED Medicare iaah-n-cwm ATLAC-Aee dynes Sakforma Male White (ot of uapante Net Fay Norman, David &. xntenx=5983_8 2K 907 a2 2030 Setfary b. shaste on/os/aa 5.0 sans cous Pay Lowboy Truce Driver 5.60 PED Taeone ep ICA w/h vb Kedteara vale white Qiot of Hispanic Wat Bay 100.57 «check petal, ‘amount 37.84 20.03 ale? aynes eaent 582.50 41.77 34.28 8,01 preery ase ae 307033 567.00 41.04 32.43 789 38.00 5.86 2.37 re 429,92 sre83 ret) 410 s6.39 10.05 646,15 56172 Page - » &. 8. Roberts Constmictian Data afaa/2a certified Payroll Kegart w/exinge Tato period end - 01/06/13, Co, Roberta Contracting, Tae. Bertod 10. — in 3372 capstal circle me PallshepsefL 32308 Job Ho, + asiao4a Marea Rehab of public Parking Okaleoga co. BOC Sec.6ae.No TUS Dep # cat mn Craft step <. Regular... . Overting . . Other Total sess Check petait. peseription Amount pringe Benefits. Nama/address ele Date Hours Hate flours Rake = ra, Hours Shasta, gatfery b. UTRA Reliwe of Public Parking 38,00 9.50 8.50 73,07 Davis Bacon Employee Wage Rate and Fringe Benefits Statement Certified Payroll End Date: 4116/2013 Project: NVFRA Rehab of Public Parking FPN # County: Okaloosa Employee Name: Jeffery Sheets Hire Date: 10/8/2012 Employee Rate & Fringe Calculations Employee Fringe Benefit Calculations Emp. Additional Hourly | Wage Table | Medical! Life 401K Paid Paid Total Cash Payment Job Pay Ins. Ins. Plan | Vacation| Holiday | Paid For Classif, Rate Rate |Fringe| See#1 | See #2 | See#3 | See#4 | See #5 | Fringe Fringe Lowboy Driver $11.00 |$12.19| $0.00 | $0.00 $0,00 $0.00 $0.00 $1.19 Overtime Hourly Rate $12.19 Overtime Hourly Rate X 1.5 $18.29 Monthly Portion of Annual Monthly Funded Fringe Total Monthly; Premium Paid by Standard Standard Hourly Fringe Benefit Calculations Premium Company Hours Hours Benefit Amout Medical Ins. (# 1) Coverage NA $0 $0 2080 173.33 $0,00 Life Ins, (# 2) 2080 173.33 $0.00 401K Plan (# 3) Unfunded Fringe Benefit Calculations for Hourly Pay Employee Paid Hours times | Annual Value (Annual Value / Rate Paid Days Hourly Rate Hourly Rate Annual Standard Hours) Paid Vacation (# 4) 0 $11.00 $0,00 $0.00 Paid Personal (# 5) 0 $11.00 $0.00 $0.00 ‘STATE OF FLORIDA DEPARTMENT OF TRANGFORTATION Statement of Compliance; DATE Ifa WAGE AND HOUR RECORD (EXCEPT ” IXGEPTION (CRAF EXPLANATION 1 Debra thse Seuretany (Nata of signatory pariy) Tite) do hereby stato: . (4) That ! pay of supervise the payment of the persons employed by Pessona Yen Sada Titente NUE Raatnal Atv ‘Contractor or Subcontractos 7 ”"SpBullding or wekk) that during the paycol period eommenging on the ++. day of Syne and ending the 5) dayof 4 all persons employed on said project have been pald the full weekly wages earned, that no Tebates have been or will REMARKS: espa ele lly or Indlteotly tq or on bsbpit of sald HES Syl sw lclusg “Tin. from the full weekly ‘(Contractor or Subcontractor) wages eamed by any person and that no deductions have been made elther directly or Indirectly trom the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitie A), issuied by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 867; 76 Stat, 387; 40 U.S.C, 3146), and described below: Fina) zac paayell tar An (2) That any payrolls otherwise under thle contract required to be submitted for the above period are corract and complefar that the Wage rates for laborers or machanics contained thersin are not {esa than the applioable wage rates contained in any wage determination Incorporated into the contract; that the classliicatfons set forth therein for each laborer or mechani conform with tha work he performed. (2) Thet any