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

BENEFITS ARE PAID TO APPROVED PLANA, FUNDS, OR PROGRAMS have been or will be made to appropriate an addition to the basic hourly wage rates paid to each labore: payroll, payments of fringe benefits aa listed in the contract programe for the benefit of such employees, axcept as noted in Section 4{c) below, +4 SEE ATTACHED BENSFIT SHEET ** (b) WHERE FRINGE BENEFITS ARE PATD IN CASH |] wach laborer or mechanic listed in the above referenced payroll has heen paid, as indicated on the payroll, Ll dn amount nat laes than the sum of the applicable basic hourly rate plus the amount of the required Fringe benefits ao listed in the contract, except ap noted in Sectiond(c) below (c) B¥cEPTTONS TORRE), SXCRPTION sxpunntto% pena NAME AND TITHE ATOURgURE Vil wh, suis wruirun exaszptcarton ov mv oP mE poawm eonrmunve un stagec mis covrakeron on MbcovanncToR To crVEL ot sana C.H, Robasta Contracting, Inc. 3272 Capital Circle WE Tallahaasert 22308 Bov-ec.No FAO Dap 8 cat iim Naxe/addrezs 188 Jattery 0, Brovn Fir) 07 on Male white (Not of Hispante Brown, Jeffery D. mK 6 Tallayns 0, Harrie 06 oy Male White (Not of @ispanic narris, laiiayne 3. aXs0 92M O07 OL David B. Motroa ©. H. Roberta Construction certified Rayrot1 Report w/Pringe Info wou No. asi10s1 NAPRA Rehab of Public Parking Oxeloosa co, BOCe - overtime . +. Regular... ceatt atep vizk Pate 2042 onas/3 7.80 12.000 oa/aa/aa 7,00 14.000 orfas/a3 ae,000 Dunp truck Briver 7.80 16.00 16.00 100 owas Aaphalt beteiburor Operator 2042 ox/iesia Dump Truck Driver Page - a Date -aypsns Period End - 92/20/13 Period No. - es ocher Totar To we ire. foura —Anovnt—“Uescription 86.63 + Grnae Pay 48.63 FED Incore 7 FED PICA x /h PED Medicare HLth-2-CHR APLAC-ACe AeLAC-8t0 check Detail. 2. brunt, 07345 vate 68.07 42.37 3.92 38-00 5.36 a7 56372 cuit, Roberts contracting, te. 272 Capital Circle NE Pallahaaperl, 32308 Soc,Sec,No FHS Dep 5 Cat Na Craft step Nane/Adareso ‘wrk dare Male white (wt of Hispanic Norman, David E. AX-Kh-5393 8 2M 007 01 2029 Veftery L. sheets onas/is oni6/i3 Lowboy Truck Driver Mata white (Not of Hispante sheets, Jeffery b. HERA Rehab of Public Parleing C. . Robaes Construction certified Payroll Report w/Fringe ob No.1 apiaest ameRA Rehab of Public Parking ‘Okaloosa co, ence Regular. Rate Howe az.as0 12,280 Info - overtime Hours Rate 18.375 Page - a“ bate - api Period Bnd - 01/20/33, Poricd Ho. - oe = Other Total 0b firs. ours aunt © Beseription aitorma Net Poy 5806.83 6.00 78.52 210 33,70 Grows ray FED Incona T FED FICA w/t EO Medicare Net Poy B50 107.22 aor.a1 p72, s11.60 Check Detail. . Begun ses 1335.39 207-48 32.80 19.37 2,028.78 STATEMENT OF COMPLIANCE Date -sat/aa a Bypoll 42 1, SHARON HACKEY (2) ‘That T pay or supervise the payment of tha persons employed by C. W. Raberts Contracting, Ino cc that during the payroll period 01/07/13 - {building ox work) HwWFRA Rehab of Public Parking Okaloosa to. BO 01/13/13; all persons emplayed on said project have been paid the [ull weekly wages earned, that no rebates have been or will be.made either directly ar indirectly to or on behalf of said (Contzactor or Subcontzactor] ¢. W. Roberts Contracting, Inc from the full weakly wages earned by any person, and that no daductions have been made either directly or indirectly from the Zull wages eared by person, other than parmissible deductions as definad in Regulations Part 3(23 CFR subtitle A), issued by Secretary of Lahor under the Copeland Act, a6 amended (48 Stat. 948.63 Stat. 106:72 Stat. 967:76 Stat. 357140 W.8.C 3145), and deseribed below: Loan #1 ) Life - AFLAC, Child Supp#1 , Uniforms , Overpayment, APLAC-Cancer _, Fortis-Dentl , AFEAC-Dental | Advance + AFLAC-HOep } ABLAC-STD 1) RELAC Withem-cwe |) Hlth-F-cuR HIER-EC-CHR ©, Hith-SS-cNR 401K CUR + bean at ) Mise. (2) ‘That any payrolls otherwise under this contract required ta be eubmitted for the above period are correct and complete; ‘That the wage races for laborers and mechanics contained therein are not lesa than the applicable wage rates contained in any wage determination incorporated into the contract; that the classification set forth for each laborer or mechanic conform with the vork performed (3) ‘That any apprentices employed in the above period are duly registered in a bona fide apprenticashin program registered with a state apprenticeship agency recognized by Lhe Bureau of Apprenticeship and Training, United States Department of Labor, or 4f no such recognized agency exiets in a dtate, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor, (3) Thar: (a) WHERE FRINGE BRNEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS I In addition to the basic hourly wage vates paid to each labozer or mechanic listed in the above referenced ---+ payroll, payments of fringe henefite aa listed in the contract have been or will be made to appropriate programa for the benefit of such employees, axcapt as noted in Section 4(c} below, ‘+ SBR ATPACHED BENEFIT SHEET *¥ (b) WHERE FRINGE BENEFITS ARH PAID IN CASH Bach laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not lead than the sum of the applicable hasic hourly rate plus the amount of the required benefits as listed in the contract, except as noted in Section(c} below i fringe to) EXcarrrons (CRAFT) EXCEPTION EXPLANATION. 4 Remarks: sawp aND TITLE srowarne ty. diy) hee qin etiage, rangxezextiow or avy oP tit asove sranouaig uae sunuece the cosrnadion ox GracowtmrcroR 79 COTE ot Teedna enobacuTion, SHU Section i061 oF TiiLE 4e AND SuChioll S91 Ge TIsUN 22 OF Tas UUITED STATES CODE. 6372 Page - a . ¥. Roberts Constmetion vata - Maras certitied Sayral] Regort w/Pringe nfo period ind = 01/13/13 C.N. Roberts Contracting, me. Baricd No. - 04 3372 Capital Circle ‘Tallabasaern 32302 ols No. asiioa, MIFRA Rahab o£ Public Parking Okaloosa co. ROE Soc.Sec.No FHS Dep S cat tn Craft step Regular... . Qverting . . Other Total wee Nane/adarass ‘rk pace Howe Rate Woura Rete Mrs. oars beserdpeion RXXUNESS7 @ LM On a3 50 Felite &, altemizano oaaa/aa 10.00 4.750 ao.o0 87.50 weve weve ross Pay Unekiled kaborer (General) 10.00 40.00 «87,30 FaD Income T PED FICA w/h FED Medicare nite - Cian hale lgpanic or Latina Hee Pay 10,00 87.0 Altamizano, Yalite b, 20.00 8.50 wxcexceo2e2 MM on? 01 2042 gerry &, Gatlin aa/20/23 8.00 38.000 400 184.00 ae steeestewe Gross Pay Dump Truck Driver 8.00 8.00 444,00 ¥ED Teena F FED ICA w/h PED Medicare slth-8-CHR aapental BSH AFLAC-ACO DRLAC-8TD Male Widta (Not of Rispanie Yer ray Freer) Gatlin, gerry.b. 14.00 DOKNK-4275 M2 MODE 02 SO Joon ¢. Hareie on/n0/2s 4.80 43.800 7.00 20.250 12.50 216.00 wela-= Gross Pay , Unekitied Laborer (General) 5.50 7.00 ag.s¢ 216.00 TED Income 7 Yap ¥ICA w/h PED Nedicaze MLtneP-CHR Bat Pay Male White {Not of Hispanic 2i6.00 216,00 narris, John c. = check peteil. . - our ans 38.63 25.67 2143 5.02 2169 290.90 ease 3,020.00 95.40 57.86 alas 12.28 768 7180 783.0, ssvsetringe Benefity-—---- page - a 6072 Cc, . Roberts Conseeuction Dake > aps certiMed Payroll Report w/Pringe Into Period Bad - 01/13/33, Period Wo. + a oR, Roberta Contracting, Ine 3972 Capltal Circie ur ‘Paldahasseet 32308 dab Wo. asnioea WweRA Rohab of Public Parking okateosa co. B9cc cee 5 Cheek Detail... nescription Amount Soc,Sec,a FHS Dep @ cab vn craft step - Regular. . .. . Overtime . . other Total Nana /adaresi rie Dace Hours Rate Houzs Rate tea, Houre SHKKK-T149 SM 608 02 1010 Lavayne @, Harrie o1/io/ia aanst Feces aaa 55.96 15.43 98.00 20.49 aa.o1 6.55 3.40 8 4.00 aaaiaa 2.50 13.250 9.50 19.895 aa.og 202,07 Aeghalt Distributor Operator 2.50 2.50 Male white (Not of Hispante Barrie, Latlayne @, NKK-RK-2324 MM 008 09 50 Matitde 4. Palacios onyaa/a3 30.00 9.800 oun 385.75, 20-05 22.42 5.22 see 3-00 309.50 Uoskitied Laborer (General) 10,00 Male dlspanie or tatino Yalacios, Matilde 8. HOKKK-5197 @ 2M 007 On 2070 gatfery 1. Shaete or/os/aa 2.50 32.290 on/a0/13 4.50, 14,255 sais 2,096.99 aayiaa 68.01 35.30 2¢3.20 Loubey truck eriver 1.50 4.80 Male white (Not o€ Hispanic aso Sheets, Jeffery 1, 1.50 6.00 100.58 HOKRK-118 8 GOT A 2042 56372 Page ©. W, Roburte Construction Dake certified Payrol) Report w/Prings Tato Period end Guts Roberts Contracting, tne. Pertod wa, 3972 Capitni Circle wo ‘allahagnert. 32308 eb He. asi04, fWERA Rehab Of Public Parking ‘okaleosa Co, BOLE S0e,826,No TMS Dep 8 Cat Ma Ceafk step +. Regular.» +. + Overtime. . Other Total Mame/addrees eke Dake jiowe Rate’ | Hour =Rate Hrs. stoura Gwendol t, Wilson nay/20/13, 10.50 10.502 10.80 Dump Truck Driver 19.50 20.50 Female white (Not of Hispanic vadison, Gvendol b. IWFRA Rehab of Public Parking 40,00 28.00 62.09 : ss + ans + on/a/a - 04 < oe. heck Detail. . Description Grose Pay 120.25 PED Income T FED BTCA o/h FED Nedicare HLek~2-cxR AFLAG-Cencer Life ~ ALAC ABLAC-AcC AELAC-STD Het Fay ‘oun aories 593.27 66.29 33.87 7.85 38.00 8.65 572 5.16 = sza.3a seserdage Benetibeesn Davis Bacon Employee Wage Rate and Fringe Benefits Statement Certified Payroll End Date: 1/13/2013 Project: NVVFRA 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. Pian |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 Date 410 1 Alison M Clark Secretary ‘(Name of Signatory Party] Cite) do horaby state; (1) That | pay or supervise ths payment of the parsons employed by (b) WHERE FRINGE BENEFITS ARE PAID IN CASH WZ — Each lsborar or mechanic listed in the above referenced payroll has been pald, a5 Indicated on the payroll, an amount no! less than the sum af the applicable bas[c hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted ln section 4(0) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION INTEGRATED SYSTEMS OF FLORIDA, INC, onthe {Canitractor of Subcontractor} NWEL REGIONAL AIRPORT PKNG LOT REN ; that during the payrall period com 10 on the (Bullding or Work) 18 dayot 12 2012 and ending the 22 _ day of, f2 2018 | all persons employed on sald project have been peld tha full weekly wages eared, that no rabates have boon er wil be made allher directly or indraally (0 or an behalf of sald INTEGRATED SYSTEMS OF FLORIDA, INC. from the full (Contractor or Subcontractor) weakly wages earned by any person and that no deductions have been made elther directly ot indrecty ‘ Part irom the full wages earned by any parson, other than pe ag defined in Regulat 429 CFR. Sublile Al, Issued by the Secretary of Labor undr tha Copeland Act, as amended (48 Stat. 848, 83 Start, 108, 72 Stet, 947; 76 Stat, 357; 40 U.S.C. § 3148), and described below: Fedatal Withholding, FIGA, and Insurance (2) That any payrolls ctherwise under this contract required (o be submitted for the ebove perlad are carract and complete; thet the wage rates for laborers or machanics contalaed therein ars rict less than the applicable waga rates contalned in any wage