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

determination Incorporated Into the contract; that the classifications set forth therein for each laborer or machanle canform with the work he performed. (@) That any apprentices employed In the above period ara duly regislerad in a bona ide apprenticeship program registered with @ State apprenticaship agency recognized by the Bureau of Apprenticeship and Tralning, United States Deparimant of Labor, or If'no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Tralning, United States Ospartment of Labor. (4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS TF ~ in action to tho basis hourly wage fatos paid to each laborer oF machanle Usted In the above referenced payroll, payments of fringe benefits as listed In the contract have bean or will be mads to appropriate programs for the benefit of euch ‘employees, except as noted In section 4(c} below, "REMARKS NAME AND TITLE ‘SIONATURE? ZY ALLISON M CLARK W) SECRETARY THE WELFUL_FALSIGATION OF ANY OF THE ABOVE BTATEMENTS (HY SUBJECT THE CONTRAGTOR OR SUBCONTRACTOR TO GIVIL OR CRIMINAL PROSECUTION, SEE SEGTION 1001 OF TITLE 18 AND SECTION 251 OF TITLE. 1 OF THE UNITED STATES COOE, bd U.S, Department of Labor PAYROLL Wage andl Hour Diviston {For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instt htm) US, Waye and Hour Divsen Persons are not required to respond fo the collection of Information unless it displays a aurrantly valid OMB contro! numbsr, Rev, Dec, 2008 WANE OF CONTRAGTOR [>] __ ORSUBCONTRAGTOR Ef AOORESS 490 SCARLET BLVD, OLDSMAR, FL 34677 ‘OMB No. 12160149 INTEGRATED SYSTEMS OF FLORIDA, ING. Expires: 12/31/2041 PAYROLL NO FOR WEEK ENDING PROJECT AND LOCATION PROIEET OR CONTRACT NO. S6FINAL 1272212013 NWFL REGIONAL AIRPORT PKNG LOT RENO ora Ow @ oy TH BAY AND GATE @ @ 7 S ® 8 FOURWGEE peauerions ver NAME AND INDIVIDUAL IDENTIFYING NUMBER: og 8 WITH WAGES: wausrroinsersersacn.secuny |88§) | woae | pic [tel ie|2o[2t| 2 hom) eas au web Peo roma | "eso NUMBER) OF WORKER g GLASSIIOATION HOURS WOARED ERDTORY ours] or pay | _evrwen | pica | "Tax, gtrsr _[oeoucTiONs} For WEEK NO LABOR THIS PERIOD ° s ° s ° 3 ° 8 ° s 3 ol 3 ° A 83, 5a, The Oo ‘While completion of Form Wi-347 is optional, le mandatory for caverad conractors and subcariractora performing vork on Fauernly faced or assisted consiructian cariracs fo eepand ta the nfrmaltan eafection canlalned in 2a CAFR: paland Act MDUS.G. 6 $146) eonractere and aubeonvactors perfomina werk on Federal franoed ar neasiet eonstalon conic lo "urich waeklye slalement wilh respect ta Ie vegas pal each employes durlag the preceding wask." U.S, Deperimant of aor (OO) regtlaions st 28GFR.§ 55(0)@Ki) eacuia corractra lo sub waetly a copy af all paycls to the Federal agency contracting far ar Amaneing te constuotonprlect, accommpanie by & signed “Statement of Compliance” indicating that the psyrolis ere aoract and comelela and thet wich era er mchar hae haen pald netless than th proger DaviBacon prevelig wage rte fr ths work peiYarmed, DOL an federelconlrectng agencies receving hs information rave te informa to deterina that omployses hav receledlenall requrod wages end ogo ben Public Burden Statement sources, gathering and rialosirng the data needed, and complating and reviewing th colon of informalion. I you have Room 82802, 200 Conettulen Avanue, NW of 58 minulas to eomplale the collection, Including tm for raviawing inetuctons, searching exis d any cammontsreparcing these estimeles or ary cfter aepec ofthe callealon, Inelualng suggestions for redvoing tls bude, send thamo the Adminstata, Wega ene Hour Dhislon, U.S, Donarment Labor, Washlagion, B.C. 20210, oon Date 01/28/2013 \ Sarah Harper Payroll Clerk (Name of Signatory Party) Tele) do hereby state: (1) That ( pay or supervise the payment of the persons employed by Bili Smith Electrio, Inc. onthe (Goniractor or Subcontractor) NWFRA Parking Rehab + that ducing the payrolf perlod commencing on the (Building or Work} 14 aot 4 , 2048 | and ending the 20 dey af i 2013 | all persons employed on a ald profect have been pald the full weekly wages earned, that na rebates have bean of will be made elther directly oF Indirectly to or on behalf of sald Bill Smith Electric, inc. (Contractor or Subconiractor) ‘weekly wages setned by any person and t hat ne deduc tlons have been m ade either directly or Innes tly {om the full wages paras by ary person other than permis decuotone a defned fy Ragulaons, Pa a Start, 108, 72 Stat, 967; 76 Stat. 357; 40 U.S.C, § 3148), and described below: FICA, Federal Withholding, Medicat Insurance, Child Support from the full (2) That any payralls otherwise under this contract required to be s ubmitted for the above perlod ara correct anc complete; that the wage rates for laborers or mechanics contained therein are not lass than the applicable wage rates contained In any wage det ermination Incorporated int ot he a ontract t hat the classiticatians eet forth therein for each laborer or mechanic conform with the work he performed. (3) T hatany apprent tcea em ployed Int he abov eperlod are duly registered In @ bona fide Bpprenticeshlp program regia tered witha St ate apprent lceshlp agency recognized by the Bureau of Apprenticeship and Training, United States Department af Labor, or Ifo such recognized agency exists Ina State, ate registered with the Bureau of Apprenticeship and Training, United States Dapartmant of Labor, (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS TF — in adlton to ths baste hourly wage rates patdl to each laborer or mechanic sted! in the above referenced payroll, payments of fringe benefits as listed in the contract have been or willbe made to sppropria ta progra ms for the bene fit of such ‘employees, exespt as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH £2] - Each laborer or mechanic tiated In the above referenced payroll has been paid, 1s Incleated on the payroll, an amount not legs than the sum of the applicable basic hourly wage rate pius the amount of the required fringe benefits a8 listed in the contract, except as noted in section 4(o) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION ite A), iesuied by the Secretary of Labor under the Gopeland Act, as amended {48 Stat, 948, REMARKS: AWE AND TLE Sarah Harper, Payroll Clerk us A bag THE WILPUL FACBIFIOATIONG FANY'O_ FT PEAl STATEMENTS MAY Ga) EOTT RECO NTRADTORO R TUECONIEAGTOR Te CHIL o8 GRIMINAL PROSECUTION SEE SEOTION 4001 DF THLE 1B AND SEOTION DO} OF TLE 31.08 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.goviwhd/formsiwh347Instr.htm) US. Wage and Hous Dison Persons are not required to respond to the collection of information untess 1 olsplays @ currently valid OMB contral number. Rev. Deo, 2008 NAHE OF OONTRAGTOR F=] OR EUBOONTRAGTOR [7] HODFESS +095 Hiadan Terrace Drive OMB No.: 1236-0008 Bill Smith Electrte, tno. Cantonment, FL 32833 Expires: 01/31/2016 PAYROLL NG, FOR WEEK ENDING PROJECT AND LOCATION PROJECT GR CONTRACT NO, 42 1/20/2013 NWF Regional Airpart Rehab Publlo Parking 1930. Fadilties, Okaloose County Gt2-1986-AP (4) (2) oy (4) DAY AND DATE: (a) © 7) @ @ A i slut ]w [ma] STs eDJetons Ce NAME AND NOWIOUAL IDENTIFYING NUMBER Ei ences aa wile (e.g, LAST FOUR DIGITS OF SOCIAL SECURITY ty work gy 4 {as[ie[ 17] 8) 19 [20] ror) pare | Aout wean | 3 | cH rora, | MAGS NUMBER) OF WORKER S68] cusssinainon TOURSWOARDERTOR—pouns|_ormay | anveo | eioa_| "rae ornen_loeaucrtons] son Week NO WORK PERFORMED THIS PERIOD e a ° ° ° 5 ° ° ° ° 3 ° ° 8 ° AR. §§ 2.9, 5.6(a). The Copeland Act ‘itis complalion of Fann WH-047 fs options) Its mandatory for eavered eonlraclrs end subcontractors pertaring work on Federally nancod or assleted cansinicllon contiscs to respand fo the information allestion contained in 29 OF {ea US. § 148 conkers answer parry wn an Feder fenced orate sartuon ons "ih vary astra hte ages pa jeach emplayee curing tha preceding wask." Ug. Geparitent of Labar (UOL) ragulatona at anos" Incoating Wat ha payrole ere coraet end complete end that each laborat 2 GF.R. § 8.5(a0)(i) require contractors to aubmit weekly copy ofall payrolls tothe Fedoret aganay contacting fr ar fnarcig the alee, >t meshes toon pl eles ten in proper DaveSeean vag wage er he et aronad OO an aden oenvacng agendas vesig hs Firman renew he omen a aed jee ae eee aga ogres wages ang bell Publts Burden Statement ing exating data sources, gathering and malntalning the data needed, and completing and reviewing the colallan af Information. I you have aul ham tothe Adninisiater, Wage and Hour Bivslon, U.S, Department of Laber, Room 88602, 200 Gonsttulon Avenue, MAW. |We estimate that e wil tke an average of £5 aninutss to eonplee lis collection, inelucig tims tor reviewing instuctons, oe any cornments ragerding hese ‘ray ator aspect ofthis callsefon, Ineluding suggections for reduelng hi burden, ‘Washington, D.C. 20210 Cor] Dete___ 01/21/2018 f Sarah Harper Payroll Clerk (Name of Signatory Party} Fille) do hereby state: (1) That | pay or supervise the payment of the parsons employed by BH Smith Electra, ino, onthe ‘(Contractor or Subcontractor NWEFRA Parking Rehab ; that during the payrall period commencing on the ‘{Bullding oF Work) 7 eyot. 2013 end ending tha_13_ day of 1 2013 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH BZ] — Bach laborer or mechanic listed in the above referenced payroll has ben pald, as Indleated on the payroll, an amount not Isse than the sum of the applloable basio howly wage rate plus the amount of the required fringe benefits as listed Inthe contract, except as noted in section 4{c} below. (0) EXCEPTIONS EXCEPTION (GRAFT) EXPLANATION allpersons employed on sald project have been paid t he full weekly wages eemed, that no rebates have been or will be made elther dlrectly or Indirectly to or an behalf of salet BIL Smith Electric, Inc, (Gontractor or Subcontractor) from the full weakly wages samed by any parson and t hat no deduc tions hav been m ads either trey or nro ty from the full wages eerned by sry persg, other than permlesble deduaions as deed | 3 20.G.FR, Subtitle A), issued by the Seorstary of Labor under ths Copeland Act, as amended ‘as pote 3s, satan (08, 72 Stat. 867; 78 Stat, 387; 40 U.S.C, § 3148), and describad below FICA, Faderat Withholding, Medical Insurance, Child Support (2) That any payralls otherwise under this contract required t o ba submitted for the above period are correct and completa; thet the wage rates for laborers or machanics cantalnad therein are not legs than the applicable wage rates contained in any wage det armination incarporaied Int 0 t he c ontrack; t hat t he clasalfteations set forth therein for each laborer or machanie canform with the work he performed. (3)T hat any apprent Ices em ployed int he sbov e period are duly registered in @ bone fda apprenticeship program regla tered w Ith a St ate apprent iesship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labar, orifno such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Tralning, United States Department of Labor, (4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS FF inaction to tho basle hourly wage rates pald to each Isborer or mechani listed in the above referenced payroll, payments of fringe benefits sa listad in the contract have been or willbe made to appropria te progra ms for the bene fit of such employees, except as noted In section 4(c} below, REMARKS: NAME AND THLE Sarah Harper, Payroll Clerk ep thnden THE WILFUL FALSIFIOATIONG FANYO FT HEAGO VEST ATEMENTS M AV GUI OTT RECO NTRHGTORO R. SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION {001 OF TITLE 18 ANO SECTION 251 OF TITLE 51