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

apprentices employed nh shove pelad ara duly altered ina bona fila apprenuicesnib program regisiarea witn @ State apprenticeship ayenoy recognizau OY te Bureau OT Apprenticeship and Trelning, United Stales Department of Laber, or f no euch recognized agency exists ina Stale, ara registered wilh the Bureau of Apprenticeahlp and Tralning, United States Depariment of Labor, 4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addition to the basia hourly wage ratsa pald to each laborer or mechanic listed in the above referenced payroll, payments of ftinge benefits as Usted In the contrat havs besn ar wil be made to appropriate programs for the beneftt of such employees, except as noted in Section 4(o) below. WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or machanle listed in the above referenced payroll has been ‘ald, as indicated on the payral, an amount nat lass than the sum of tha applicable basic hourly wage reta plus the amount ofthe required fringe benefits as fetad in the contract, except as noted In Section 4(c} below: NAME AND THLE [SIGNATURE Seater | LMA Uatche THE WILLFUL@ALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY ISUBJECT THE CONTRACTOR OR SUBCONTRAOTOR TO CIVIL OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SECTION [204 OF TITLE 81 OF THE UNITED STATES CODE. nooioe Ceonetucton oat 700.010-69 wiser Geren or Wage and Hour Record: Dontractor's Nema [ Poronat ome Guldere, ne. 1 ativan [Gsvane anno Worl, Homa ooter 1 seyralNunber a Ferwookérars = [Pot eo {T= | Contest CTsTTOaT| Polat and Lenton Awa Sd Tiy i) (5) a (ey 10} Eloy ame (4) Day and Date | sity [otal] project (8) Peductlons nat ttages | Tot trom and Digit dente [ Hours roms [FIER 7 WHE ela Tom Tout | “pale for. [erage ferent {@ digit $8 and full acdross: ic 0 i ‘eaky holding Degneton Deductions wook ‘Sheat eden contote at a "svfnrto tae)" | "Reco {Work Choa £ |" none ™ faltached) {atecresh aoncer | toavion | ENV] ebay ilychgliy Gortal |, 2 at sony iw \SUS ww Wl Cab [1S ® fisy fava G1 [789 Th eS | gloss Babny Hirts arse & x | LoIGO [Oa leone [1B ©, [ase [R®.@ [11,20 GR [eo Uo | 90.44 lo A £ o 6 3 lo s $ lo le $ lo Is $ o ER 8 = a 5 A $ lo a 8 lo is £ = 700-010-690 Construction O21 Deductions Record: Contractor'a Name [ Personal Home Bullders ] Addrees[2263 Horse Bem Road Weelville Flosida 32404 Payroll Number| ta] contact] TETTOAT Project and Location Type a Deduction description in each box and then record the amount of that Deduction far each employee {or leave blank). Employee Name (last, first) ; sacl mployee Name (last, first Deductions Gi | GA Amount V4 la Dabney Curichoshey™ . Drobo, Kren” BN [ad ; 160. US STATE OF FLORIDA DEPARTMENT GF TRANSPORTATION Statement of Compliance: DATE lela tian | Dabra Gubike, Seurebary WAGE AND HOUR RECORD (c) EXCEPT. yo0.t0-09 Canatuctan out IXCEPTION (GRAF: EXPLANATION. (Nate of signatory party) Title) do heraby state: (1) That | pay of euperviee the payment of the persons employed by Parsone) ou Burlisaencanne WEA tonal Moot “(Contractor or Subcontractor) =p Guang oar SMP that during the payroll perlod commencing on the PT cay of and anding the day of | all persons employed ‘on aald project have besn paid the full weekly wages earned, that no rebates have been or will ha made elther directly or Indirectly tg or on behelf of sald Aoersonal Some Wi eyo (Contractor or Subcontractor) wages earned by any person and that no deductions have bean made slther directly or Indirectly from the full wages earned by any parson, other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (46 Stat, 948, 63 Stat. 108, 72 Stat, 87; 78 Stat. 357; 40 U.S.C, 3146), and desorbed balow: from the full weekly SEE ated pao hr Caetima (2) That any payrolls otherwise under this contract required to be submitted for the above period ara correct and completa; that the wage ratas for laborers of mechanica contained therein are nol Jaga than tha applicable wage rates contained In any wage determination Incorporated! into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work ha performed, (Sl Thatany apprentices ero din tha abova period are dull registared In a bona fide apprenticesnib program ragieterea wien a state Bpprenicasnip agency recognized oy tne BUFeAU OY Apprenticeship end Trelring, United States Department of Labor, of ifna such recognized agency existe ina Stata, are registered with the Bureau of Apprenticeship and Tralning, United States Department of Labor. (6) That: fa) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addon to the baelc hourly wage rates pald to each laborer or mechanic Bted in Ihe above referenced payral, payments of frings benefits as Iisted In the contract have been or wil be made to anprapzlate programa for the benefit of such employees, except as noted in Section 4(c) below, fb) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or machanla lisfed in the abave referenced payroll has heen ‘paid, 2s indoated on tha payroll, an amount not fees then the sum of the applicable basis hourly wage rate plus tha amount of the required fringe benefits as sted In the contract, except as nated In Section 4(c) below: REMARKS: NAME AND br [SIGNATURE why, WAM, \ f Suu ~ THe: WILLFULFALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO GIVIL OR CRIMINAL PROSECUTION, SEE SECTION 100¢ OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Wi8e7 700.10-68 onstation ont Wage and Hour Record: [ashes sinha Woon 2 Contractor's Name [ Pereoral Homo Builders, i, ] Aaddgeos Pyro Numbors TS] recom = CLS Ta] ontrack Pojoot and Lavaion i B) Go] Enea Name (4) Dayand Date | rie rohet (8}__ Deductions NetWages | Tota from and 4 Digit Identitior [ I I Hours Groasf PICA With ‘Total fron Fatal Pald for | Fringe Benelft| (@ dlglt 98 and full addross a i Weakly holding Poduction | Deductions | “Week Sheet required an contracts Lat } exemptions / 8) ite Grose tox ‘Sheet {attached) ‘rior to 4/58/08) Rnae& = | Work Ciageitel (attached) Gener_| tention [3 uf Baty Chitiigghe) me) 8B - Cone 2 - Ss [ur [adams | Le 8 [selva |6R 787 MM. tots | gloss Monty KML Gerveth | B ey, Cords [iow daloee SMESNE SS Aieco "Bo [106.6% [sFb fi ED £ = bo IS S = o E £ = o Is $ o Is $. lo le $. e is $ a Is $. i Is. 5. = 700-010-869 Construction 02/11 Deductions Record: Contractor's Name. Cc Porsonal Home Bulldars ] Address [2283 Hores Bam Roed Weetille Feria 82464 ] Payroll Number 125] For Weok Endina| contracta[ 154104 Fine [oo Projact and Location[ NW Regional Airport, Walton Type a Deduction description In each box and then racord the amount of that Deduction for each employaa (or leava blank). Total Employee Name (last, first) \ (5: Deductions C A Amount Dabney Unrichahyc Eas Resta’, Ky-04 8 7.a0 [2.06 [oa to at rw) ‘STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Statamant of Compliance: DATE ola. 1 Deelsca Leathe, SS eerstovy WAGE AND HOUR RECORD (co) EXCEPT youo1ee Sunsineton oat IXCEPTION (CRAF’ EXPLANATION (Name of signatory party) (Title) a do hereby state: (1) That | pay or supervise the payment of the persons employed by Avesorul Hone, Bull divic ANC on the Nwe Recjoval Aloo (Contractor or Subcontractor) (Bullding or work) that during the paytef pv eommeneiag on treF cayor Debember- and ending the day of Deora all persons employed on sald project have bean pald the full weekly wages eamad, thafno rebates have been or will mete etna rly ony ctly fo or on behalf of sald tsorol treme. Tht (Contractor or Subcontradtor) wages earned by any parson and that na deductions have besn made sither altectly or Indirectly trom the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CR Subtitle A), Issued by the Secretary of Labor under the Copsland Act, as amendad (48 Stat, 948, 43 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 3146), and described below: from the full weakly REMARKS: Le Gia pagel Schad ative. (2) That any payrols othenvse under this contract required to ba submitted for the above perlod are carrect and complete; that the wage rates for laborers or mechenles contained therein are not lesa than the applicable wage rates contained in any wage datarmination Incorporatad Into the contract; that ine ciaseffications sot forth thereln for each laborer or mechenlo conform with tha work he performed, (2) iat any apprentices employed ig tha above paved ara duly registered ip a bona fda ‘Snprenticesnip program registered with a State apprenticesn|p agency recognized by ine LUreaU Of Apprenticeship and Tralring, United States Department of Labor, or if no such recognized agency exists Ina State, are raglatared with the Bureau of Apprenticeship and Training, United States Departmant of Labor. ) That: (3) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS in addition fo the basic hourly wage rates pald to each laborer or mechanio sted in the abave referenced payrol, payments of ftinge benefits 2a listed in tha contract have been or will be mada to appropriate programs for the benef of such employees, except as noted in Seatlon 4(c) below. fo) WHERE FRINGE BENEFITS ARE PAID IN CASH ach laborer or machanio ilsted in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sums of the applicable baele hourly wage rata plus the amount of the requirad fringe benefits as l[sted in the contract, except a noted in Section 4(c) below: NAME AND TITLE [SIGNATURE Sactgla ny bukoby {THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO GIVIL OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SECTION 1231 OF TITLE 31 OF THE UNITED STATES CODE. oao10-68 wad; 7 . Conatuation Onis Wage and Flour Record: ] Contractor's Nama. Parsonl Roma Butldars, Ino, } Addross [2263 Home Bam Road tosh, Plriés 20464 Payroll Number [CEES] rorweokendre = Pde pte PS Contact Prolast and Looston ie ’ 5 7) engies Name (@) Day and Date “Tai Toasts] poet {5)_ Deductions Nat iages | Totton so Soap oor ion et ag Sour] Tor] Netges | Toll fom {edights8 andrall address | (2) in Waatdy hataing Deduetion | Deductiona | “Wook Seat Tequlred on contracts Lat | Exomptione/ Tel ged! Grose tax ‘Bheot {attached prior to “#419008 Race & [Work Classif-|2] . {attached) Gender Icatlon | #KO Delong) Cnihgh fovnmel | 6 a em . ists WAC ee ls B liso ie | og [287 [4.x |sjosa Dalry, Ying Conve) 8 ; bo | 6 un ERS B Hho Bia flor. bo | Wag LolG Labbstey”|, OSD Aaro Pah o . t 0 s lb ES $ —. q IB, S = o ls $ 5 EJ $ — o ls $ 0 IS. $ ~ 6 EI $ = 700-010-608 Construction 02i4 Deductions Record: Contrastor's Name [ Pargonai Home Bufiders ] Address[z263 Horse Gam Road Wesivlle Florida 32484 } PeyrollNumbor| 1 | ForWeck Ending’ f= Joa. | contracal TET108 Fine [2 Projsct and Location| NV Regional Alrport, Walton, ‘Type a Deduction description In each box and then record the amount of that Deduction for each employes (or leave blank), , Total Employee Name (last, first} | Deductions Gq A ‘mount TELS Subp Kits Bi1ad [S.00 Hod. bb 01/07/2013 Date 1 Sarah Harper Payroll Clerk (ame of Signatory Perly) Ties do hereby stata: (1) That | pay or supervise the payment of the persons employed by Bilt Smith Electrlo, tne. onthe Contractor or Subcontractor) NWFRA Parking Rehab ; that during the payroll petlod commencing on the ‘Gullding or Work) : 24 ayot___12 2012 endending the 20 dayot__ 12, 2072 all parsons employed on 8 ald project have been paid E he full weekly wages eared, that no rebates have * been o will be made either clrecty or indirectly to or on behalf of sald Bill Smith Electric, Inc, from the full ‘(Contractor or Subcontractor) Weekly Wages earned by any person and that