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

no deduc tlons have been m ade elthar dlreatly ar Indiras ly (b) WHERE FRINGE BENEFITS ARE PAID IN CASH [2] — Each faborar or mechanic listed in the above raferencet! payrall has been pald, 9 indioatad on the payroll, an amount not tesa than the sum of the applicable basle hourly wage rate plus the emount of the required fringe benefits as listed In the contract, exoapt as noted in section 4{c) balow. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION ‘trom the full wages eared by any person, other than permissible deductions as defined In Regutations, Part ne 3 (29 C.F.R. Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amanded (48 Stat, 848, ¢ s 5 98 Start, 108, 72 Stat, 087; 76 Stat, 387) 40 U.S.C. § $146), and described below: FIA, Federal Wlihholding . (2) That any payrolls otherwise under this contract required to be s ubmitied for the above period are correct and complete; that tha wage tates for laborers or machanies contalned thersln are nat lees than the applicable wage rates contained In any wage det etmination Incorporated int 0 t he c ontrect; t hat the classifications set forth thereln for each laborer or mechanic conform with the work he parformec {9} T het any apprent ices em ployedint heebov eperiad are duly registered In @ bona fide apprenticaship program ragis tered w ith a St ete apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or fne euch recognized agency exists Ina Siete, ars registered with the Bureau of Appreniiceship and Tralning, United States Department of Labor, (@) That, (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS OF _ insaton to tha basle hourly wage rates pald fo each latorr of mechaieIsted in the above referenced payroll payments of fringe benaffits as Usted in the contract have been of willbe made fo approniia te progra ms for the bene fit af such employees, except as notet in section 4c) below. 'REWARIS: THAME AND TILE Barah Harper, Payroll Clerk SIGNGTPRE TEAEO VET ATEMENTS MW AVGUBJ ECT T HEGO NTRAGTORO R THE WiLLFUL FALSIFIOATIONG F ANY, SUBCONTRACTOR TO GIMIL OR ORIMINKL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SECTION 284 OF TITLE E. 34 OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL WH Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.goviwhdiformsiwh347instr.htm) U.S, Wage und Hour Divleton Rev, Deo, 2008 Parsons ate not required to reepond to the collection of information unless ft dfaplays = currently vali OME gantrof number. NAWB OFcoNTRAGTOR [7] ORBUBGONTRACTOR ‘ADDRESS 4995 Hicden Tatras Drive OMB Now 1296.0008 7 Bitl Smith Elecirlo, ino. Cantonment, FL. 32533 Expires: 01/91/2015 PAYROLLNG. FOR WEEK EHOING FROVEOT AND LOGATION FROIEGT OR CONTRACT. 30 42/30/2042 NWE Reglonat Airport Rehab Publle Parking 19884 Faclities, Okaloosa County 012r1988-AP cy oy DAY AND DATE @] @ @ Ye ulelwlalrleTs vent thons _ NAM AND INDIVIUAL (DENTIFVING NUMBER — | & Ross cui WAGES Ge asrrouroiotéorsookesecuny | [8E work | [2s]26[a7[ael a9 aol orm) rare | ARS wane | ae | ate, Tora, | MASE NUMBER] OF WORKER G58] custom |” -—povaswoatebencroar—hours| orray | earwes | rca_| "tax orner focdvortons| ron WEEK Rodarick Wolfe 6908 Electrician [0 isa92.15 0 $30.00 | $44.00 . $7400 | $318.15 A va} 0 fuze 23,0( i705 Aon1s Brian Anderson 8768 Genersl fo 216.00 Q Laborer $162 | $18,00 34s | $181.48 3 0 a ee 60 $216.00 a 2 ° iced of aoslsted aonsiruction coniraca fo raypond fa the Information eallestion corned In 29 G.F.R, $8 2.3, 8.8(s), The Copeland Act Ig) a atatoment th rospedt ts ine wages pid aech employee during the precading week" U.S, Dapertment af tebsr (COL) regutaane at by a stggod "talement of = indoetng thatthe pyro ae correct and aompele and that each laborer tis informetlon revlon the information te datermine that eroplyees have received legally required wapes and ings heres, ‘Wile cormpletion of Form WH247 Ie oplfane, Is riandelry for covered contracora and subantraatovs performing work on Fadarsly ta (40 US.6, § 9148) contrastars end aubeantrtors performing week on Faderaly francad of astleted conslyunton donircts fo "urnish wee “29 GER. § §.6(2)(6\) require contractor (o submit waskly a capy ofall payrolls to the Federal agency: tor oF naneing he: projec, ‘or macharia hae tigen pat ot fas than the preper Qavi-Baoan provltng wage rats forthe work performed, DOL and faral cantacting agencies receiving Pubite Burden Statement gathering and melnisining the data nesdad, and competing end reviving the collection of Information. you have ge ord Hour Bvilon, U6, Department of Labor, Roam 89602, 200 Consisaion Avenue, No ‘We estat that I wl take an average at 65 mires fo coruplate this colecton, Inelucing tme for reviewing Ineructona, searching xtstng date sources, ny comments regarding thaes estimates of any other aspect of thls calledion, Including suggewtloné fer raduolng this burcén soncl them ta ths Agwristratr, Weg ‘Washington, D.C, 20210 vet STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: (co) EXCEPTIONS, DATE January 9, 2013 EXCEPTION (CRAFT) EXPLANATION \ Mary Ann Scurlock (Name of elonatory party) ite) do hereby stale: (1) That pay or supervise the payment of the persons employed by Gustiler & Guettiar, Ine onthe FIN #012-1939-AP, (Contractor or Subsontactar) (Bullatng or work) thatduring the payroll parfod commencing on the 30th dayof December and ending the th dayof “January all parsons employed con sald project hava been paid the full weekly wages earned, thal no rebates Nave been or vl ba made either Ulractly or Indirectly to or on behalf of sald REMARKS: Gusttior & @usttir, no from the fub weekly {Goniracior or Subcontractor) ‘wages eamed by any person and that io deductions have besn made elther directly ar Indleecty from the Tull wages eamed by any person, other than permissible deductions as defined In Regulations, Part 2 (28 CFR Subtle A), tssued by the Secretary of Labor under the Capeland Act, a8 amended {48 Stat. 948, 68 Stat. 108, 72 Stat, 967; 78 Stat, 957; 40 U.S.C. 9148), and desorloed below: FIGA, Withholding Tax, Medicara, Child Support, NO WORK NAME AND TITLE. [SIGNATURE 700-010-689 Construction O21 @) Thot any payrolts otherwise under thls contract required to be submitted for the above petlod are correct and complete; that the wage rates for laborers or mechanies contained thereln are nat less than the applleable wage rales conteined In any wage determination incorporated info the contract; that the classifications sal forth thereln for each laboter or mechanic conforma with the wark he performed. (@) That eny apprentices employed In the above parted are duly registered Ih a bona fds apprenticeship program registered with a Stata apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, of If no such recognized agency exists ‘na Stato, are reglatered with the Buraau of Apprenticeship and Training, United! States Department of Labor. (4) That fa) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS an additlan lo the basis hourly wege rates pald to each laborer or mechanic listed In the above referenced payrall, payments of finge benefits as listed In the contract have been or will ba made to appropriate programs for the benetit of euch employees, except as noted In Section 4(6) below, (®) WHERE FRINGE BENEFITS ARE PAID IN CASH [Each laborer or mechanio listed tn the above referenced payroll has been ald, a9 Indicated on the payroll, an amount nat less than the sum of the applloable haste hourly wage rate plus the amount of the required fringe benefits as listed In tha contract, except as noted in Section 4(c} below itry ann Seuracs lWaurlwsl crorlock| THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE) SECTION 1001 OF TITLE 18 AND SECTION 234 OF TITLE 31 OF THE UNITED STATES CODE. 700-010-68 ween Conaiquatlan ont Wage and Hour Record: Contractor's Name [ Guoitar & Gutter, In i Aarons (Beating, Sip A. ee —_] Payroll Numba 36_| For Wak Evang “Taniiary 5 2078 ] contcact# Project ant Location TRATFL Regina Argon FIN 7 @ 7 o a) fons ®) (io) onetlaae (Bay and Date |S Jose] eal |_—___— 8) _Decuctions Tah | salon ‘and 4 Digit tdontifior . | Hours Gross! G ihe] Medloare tal fram Paid for | Fringe Benet co Sphes ar aes | n{ wf re weston] To itt bata Fein | vesctone | "oer |e Be required on contracts Lot | (2) @ oi Grose tex shoot {alinehea prlor to 4749/09) exemptions | [Wark Classitel ® {attached} Race Gente] tention | yosol aeal_in | we | ve | | vs fetta ts Taylor $-0, Oo 0,00 _| wieiiitiit| VALUE! xxxexkee6 wivtgale | Foreman [5 aoa | Salary $0.00]$ Ryan Gray ua lo 0.00 avant #VALUEL AKAROA WhitesNato Foreman |S 0,00 Salary, $0.00} $ “. ciifton Gatden BA. lo 0.00 | zieittititt| #VALUEL RXXXNPADZ White/ttato | Foreman _[S ooo | salary $0,001 §. = lohrie Taylor 30 lo ooo | 2150 | 909 gLet Lxxxece-r2e0 ‘whitttare| sting | aon | 1420 g0.00|$ aril Geom 50 lo 0,00_| 15.00 | 0.90 oH famnacat DXxXX9GET Siackiete| Laborer _|s a.a0 | 10.00 30.00 $ ia Wilbur Bdainger ea sa} lo ooo | 20.26 | 9.00 Machina xxxexxas40 Whttemiate | Nozzlmman |S o.oo | 18.60 go.og]¢ _- Scotty Davis 51, oO EQ lo 0,00 24,28. 0.00 Unehina XXX TE Whitostialo. Operator [3 0.00 14,28 $0.00] $ =. [loseph Bish, dr 84d a lo sv | 1500 | 9.00 ‘Baenerai XXK-KX98 16 Yihitafifale Loborer_|s 0.00 10.00 $0.00] $ ~ faust Whitington sad ap, lo 0.09 _| 15.00 | 9.00 Fsnoral JRXK-XX-7644 White/Male Laborer |S 8.00 10.00 $0.00/_$ ~ Bly Thiel £2. qoicommonl?. ooo | 1726 | 9.00 ‘General XXXKX-H296 White/Bfale Laborer |S 0.00 11.60 $0.00] $ “ [J8son Losthorwoad Mee) ro lo 0.00 | 15.00 ‘1Genoral [XK 8607, whiterttete| _ignborer_{s oa | 40.00, $0.00} $ =. Date - 4/25/13 569373 ae > STATEMENT OF COMPLEANCE 1, SHARON MACKEY J8HO OFFICER do heraby state: (a) that T pay or supervise the payment of the persons employed by C. W, Roberta Contracting, zac on the Qouilding or work) NHFRA Rehab of Public Parking Okalovsa Co, BOCC that during the payroll period 03/14/23 - ga/20/13", all peteone anployed on said project have been paid the fl] weekly wages earned, that na rebates have been or will be nade eltnar directly of Andireatiy to or on behalf of said (Contractor or Subcontractor) ‘C. ¥. Roberts Contracting, Ine from the Bull weekly wages earned by any pexeon, and that no deductions have been nade either directly or indixectly from tha full wages earned by person, other Chan permasible deductions a detined in Regulations Paxt 3(28 CER subtitle A}, Sanued by Secretary bf Labor under the Copeland Act, aa amended (49 Stat. 940:63 Stat, 10872 Stat, 967176 Seat. 357:40 0.9.0 3288), and described below: foan #1 ) bige ~ AFLAC, Child Supp#l , Uniforms , Overpayment —, AFLAC-Cancer =, Fortia-Dantl AFLAC-Dental , Advance 1 AFEAC-Hoep ) APLAC-STD + AFLAC TMleh-B-coR |; HIEA-P-CHR With-se-cwn «—, HIth-RS-CHR =, 401K CHR > bean #1 2 Mise : vequired to be submitted for the above period are correct and completes therein ara not lese than the applicable wage rates contained in any (2) That any payrolls othereiae under this contract ifleation aet forth for each laborer or mechanic conform with That the wage rates for laborers and mechanics containe: wage deternination incorporated into the contract; that the class: the work performed {3} that any apprentices employed in tha above period are duly registered in a kona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Depaxtment of Labor. or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticaship and Training, United States Department of Labor. (a) That fa) or mechanic 1igtad in the above referenced a FRINGE