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

fulladdress| Flee renin Weeki hotding Dedueion | Deductions | Nees Shee eerie barerriad emer eo oe te tot tlachoy " Gee | eatan (BLM! 37 [a veto Chad Bop lee Bensrey |, ay oT" 105, 3e3s Wf A | cabo [3 BIR Ot Bond th] ty.20 19,83 | 30.63 (fe5%) Usa paall at a sts [uPrcobeer | (RIB Of [ew Bw.6 | 87.43/08 58-77 |awas Kreg TDebne] oct, att a =; Loi afin bebe | /519 18 Babs fea ob [SBMo [LH BPA [45.70 | wan , iS & i A s lo 2 a bo is & o . ‘ lo ie i £ Hi o | ls ji Is. 3 700-010-68 onstruction oa+ Deductions Record: Contractor's Name [ Personal Home Bulldars ] Addrasofgaas Horse Bum Ros Weahile Fonda S246 ] Payroll nurter{ [2] For Week Ending|_LL | a Contract # fing [_ Project and Location [iW Regional Alrpoay Walton Type a Deduction descrtatlon in each box and then record the amount of that Ducuction for wach employee (or leave blank}. Total Employee Name (last, first) C 7 Deductions : \ . Amount, Bawwler Grad, SQ OR Maloney Crnichehe* ; aa Dobra) a2 7 PE 3b] 9b 4s 76 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: {c) EXCEPTIONS 700-010-69 Construction 02/11 DATE January 23,2013 EXCEPTION (CRAFT) EXPLANATION 4 Mary Ann Scurlock (Name of eignatory party) Tite) do hereby state: (1) That | pay or supervise the peymentof the persons employed by Guettler & Guettlay Inc. on the FIN #612-1930-AP ‘(Ganiractor or Subcontractor) {Bullding or work) = that during the payroll period commencing on the 48th day ot January and ending the ‘9th dayot “January ‘al parsons employed on sald project hava been pald the full weekly wages eamed, that no rebates have been or wll be made alther directly or Indiractly to or on behalf of sald REMARKS; Guetilar & Gusti, Inc from the full weekly {Contractor ar Subcontractor) ‘wages earned by any person and that no deductions have heen mada elther directly or Indirectly from the full wages eamed by eny person, other than permissible deductions as definad In Regulations, Part @ (28 CFR Subtitle A), ssuied by the Sacratary of Labor uncer the Copeland Act, as amended (48 Stat. 248, 69 Stal. 108, 72 Stat, 087; 78 Stet, 297; 40 U.8.C. 8146), and described below: FICA, Withholding Tax, Medicare, Child Support NONE. NAME AND TITLE ‘SIGNATURE (2) That any payrolls otherwise under thls cantract required to be submitted for the above AM Cenk wok perlod are correct and complete; that the wage rales for laborers or mechanles contalned therefn sre not Mary Ann Scurlock he tH THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE Jess than the appilcable wage rates contained in any wage determination incorporated ito the contract; that te classifications set farth therein for each laborer or mechanic conform with the work he performed. (2) That eny apprentices employad in the above parlod are duly registered in a bona fide appranticaship program registered with a Stata apprenticeship agency recognized by the Bureau of Apprenliceship and Tralning, United States Department of Labor, or Ifa such recognized agency exists ina State, are cagistered with the Bureau of Apprenticeship and Training, United Staiss Department of Labor, (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS a addition fo the baste haurly wage rates pald ta each laborer of machanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or wlll he made to appropriate programs for the benefit of such employees, except as noted in Section Ao} below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH - [k____] each taborer or mechanic iisted in ihe ahove referenced payroll has besn peal, 29 indicated on the payroll, an amount not fess than tie sum of the applicable hasie hourly wage rate plus the amaunt of the required fringe banetite as listed inthe contract, except as noted in Section 4(0) below: STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. 700-010-69 38 wees Constiuction ot i Addons [eigen citer azn el Projoct and Location TREC Fesforal Ao BAAR Wage and Hour Record: ‘Guster & Guetta Ine. Contractors Name Payroll Number: [| Forwescenaing §— [ “Tenuary 18, 2048 ] Contract # rie a (6) (8) (8) {70} employen Namo (4) Day and Date | if) [astute] praeer (8) _Deductions NetWages | Totl rom and ADI otter sal won| wool woalmnadl ex [en Hours Gener [RGA] Wine] weatebts Tourn] Taay — Netagee | Toul om {G diol SS and full address i Weakly holding Deduotion | Deductions week Shoot ‘required on contracts Let @ @ 3 Gros tax Sheot {attached} prior fo 1719/08) Exemptions / [Work Clasait) & attached} race Gender) tation [Fig | wre | vis | ane wir | ane | te Wen Toyor 86, lo 0.00 _ { AHHH! VALUE! XXXXK- BIDE White/tiale. Foreman |S 41.8 4.80 Salary {1,380.00 18.3,70|_ $249.00 $19,87| $352.27] $ 997.73 ur angor ighwayia ea_| MananPaly eon | 2028 | zo25 tipi [MKXXKO5AO White/Aale Painter |S 4.5} 41.80 13,80 889,88 | § 62.941 § 108.00 |$ 12,38 $171,32| $682.56 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: 700-010-689 Construction 02/1 DATE, January 16, 2013 {c) EXCEPTIONS: EXCEPTION (CRAFT) EXPLANATION \ Mary Ann Scurlock (Name of signatory party) tia} do heraby state: (1) That | pay or supervise tha payment af the persons employed by Guettier & Gusttler, Inc onthe FIN HO12:1980,AP (Contactor or Subcontractor) (Bullding oF work] that during the payrall perlod commencing on the th dayof January and ending the 42h dayof January ‘all persons employad on said project have been paid the full weekly wages earned, thet no rebates have bean or will REMARKS: bs made elther dlractly or indirectly to ar on behalf of said Guattler & Gueitler, Inc. frorm the full weekly (Contractor or Subcontractor) wages earried by any person and that no deduations have besn made elther drectly or indirectly from the full wagas earned by any person, other than permissible deductions as defined In Regulatfons, Part 3 (29 CFR Subiile A), fasted by Ihe Secretary of Labor under the Copeland Act, as amended (48 Stat. 048, 63 Stat, 108, 72 Stat. 967; 78 Stat. 367; 40 U.S.C, 9148}, and described below, Court Ordered Deduction FICA, Withholding Tax, Meuicare, Child Support ‘See payroll sheet for deductions. {2) That any payrotte otherwise under this contract required to be submited tor the ebave period are correct and complate; that the wage retas for laborers ar mechanics contalnad thereln are not fess than the applicable wage rates contained in any wage determination inearporated into the contrac; that the classlications set forth therein for each laborer or mechanic conform with the work he performed, (@) That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenliceship and Training, United States Dapartmant of Labor, or f na such recognized agency exists ina Stats, are registered with the Bureau of Apprenticeship end Training, Uniled States Department of Labor. 4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS tn edaillon to the besle hourly wege rates peld to each laborer or mechanic listed In the above referenced payroll, payrmants of fringe benefis as listed In the cantract have been or will be made to appropriate programs forthe benefit of such employees, except as noted In Section 4(c) below. (o) WHERE FRINGE BENEFITS ARE PAID IN CASH ean laborer at machanie listed In the above referaniced payroll has been paid, a8 Indlested on the payroll, an amount not lass than the sum of the applleable basic hourly wage rate plus the amount of the required fringe benefits as Yoted in the contract, except as noted In Seatlon 4() below: NAME AND TITLE SIGNATURE Mary Ann Scurlock MM gglrmnsdeaidech, 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 231 OF TITLE 31 OF THE UNITED STATES CODE, WH3d7 700.010.89 Construction ares Wage and Hour Record: Cantractor'a Namo I ‘Guetiler & Gusttler, Inc. ] Astdtess [S24 Hy 00, Ghia, FL 328 Payral humbs (RT) rorweek ening = (damian oe 7] contract? ae Projet and Locatton FINA lerzasse.aP Tw an a Ty) (i) Emptoyse Name 4 Day and Date ‘Total | Pay Rate} Profock (8) Deductions Net Wages | Total from and Digit dont Sun] Wer | Toes] weal thaws] ral sa| Hours arose! “| FGA] Wilh] Medioare Total rar Tal Pald for | Fringe Senet {@ aight 3 ana fll aderons teat weekly holding Deduetion | Doductions | "Ray Sheat raga on eaniracts Lat | (3 ic) Gross tax sheet {attached rl fo 119709) | exompttane [Work Class (attached) [Race & Gender] icstlon ve [vg | w | wf seo) gy | se [ls Taylor 30 lo 0.00 | eanenen) avaue! XXX-XX-3996 Whitefttale Foreman _|$ a 3,00. Salary | 1,260.00. $83.70] $264.00) $13,63) $354.28] $995.72 Ryan Gray 9 o as] 450 _|wamanal wvatuer JXXX-XX.0827 WhiteH#Aal Foreman |S 0.00 Salary | 4,160.00 | $ 7H30/$ 13200/$ 18.60 $249.98] $ 930,02 lwtiour Baninger 34 sing ooo _| 2025 | 40.00 Machine XXXXK-0840 WhiteMala | Nozzioman |S 3 3.00 | 13.50 | 75283 |s 4666/5 a7.00|$ 10.51 $144,87| $808.08 Lfosaph Bish ar 2 lo as|_4s0_| 15.00 | 97.80 Lexx.xn.s0t yuutonmors| Laborer |S ogo | 1000 | serso jg seas |¢ cs.0o]s 552 107,96, §_470.56 [Asotin véritington 20) an jo o.90_| 15,00 | 50.00 ‘ganeral XXX-XX- Edd Watto/tals Laborer _|5 E 3.00 10.00 415,00 | $ 28,73 |$ 48.00 |G 6.02 $78.75| $ 335.25 lBniy var 0! apy o as 4a0 | avs | y7ss ‘Ganorat XXX-XK-B 298 WhiteilMale Laborer |S 0.00 14.60 867,00 ALAS |$_ 96.00|$ 9.57 $148.02] $_ 520,08 Liason Lodtnerwaoa ae lo ooo _} 16.00 | 30.00 ‘WGanerah [XKK-XX-BBO7_ White/Male Laborer jS 3 3.00 10.00 550.00_ | 34.40] $ 25.00] $ 7.88 $ 90,00, $1597.08] $ 392,92 Deductions Record: 700-010-68 Construction Contractor's Name [ Guettler & Guettler, linc. 1 Payroll Number: Contract Project and Location[ NW FL Reglonal Alport. For Week Ending| January 12, 2013 FINE Address 24 Huy 00, Chipley, FL 82428 i 0214 ‘Type a Deduction description In each box and then record the amount of that Deduction for each employee (ar leave blank), Employee Name (last, first) Child Support Total Deductions Amount, Leatherwood, Jason Child Support $80.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 STATEMENT OF COMPLIANCE s06371 F af |. SHARON MACKEY FEO OFFICER do horeby state; (1) That “| pay or supervise the’ payment of the persons employed by 6. W. Roberts Contracting, ine on the (bulging or work) NWFRA Rehab of Publle Parkin, thal duing the payroll period §— 1/0413 | 1/2719 call persons employed on been or will be made elther directly or indirectly ald project have been pald the full Weekly wages samad, thal no rebates hava fo or on behalf of sald (Contracior or Subcontcacion) ¢, W. Roberls_Convactlng, Ino fom the full weekly wages sained by any person, and hati datuctone nave been mada _sliner direcly or Intrecly trom tha ful wages eared by any ptson, other R Pat 3 (28 CFR Subltle A), fssued by Secretary of Labor under the Copland than as defined in Act, as amended (48 Slat. 948;49 Stal, 108; 72 Stat, 967/76 Slat. 95740 U.S.C, 2145), and described below: oan #4 . bite = AFLAC |. Chitd_ Supp t Uniforms ‘Overpayment AFLAC Cancer, Fortis - Dsnti “APLAT- Danial Advan AFLAC Hosp". AFLAG- STO AFLAC. Ah -E- CWE. An -F- Cw “Hin €C- WR Aith- ES CW. —a07K_ OWE Coan #4 1 Me Foquired 19 be submited for te abaya period are camect and completa; therin are nat less than the eeplicable wage rates contained In any @) That eny payrolls othenwisa under thls contract set forth for each laborer or mechani conform — with Thal the wage rates for laborers ané mechanics contalned wage dsterminallon