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

inescporated Inia the contract: that the —clasetfeation tha woik performed employed In the ahove period are duly registered in bona fife apprenticeship program registered recognized by the Buresu ot Apprenticaship and Training, Unled States Department of Labor, ()_That_any apprentices ‘of Apprenticeship and Tralning, United States with State apprenticeship agency or if no such recognized agency oxlste in a Slate, ars registered with the Bureau Department of Labor. (@) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS mechanic listed in the abave referenced or will ba made to appropiate betow, nation to tha baste hourly wage rates paid to each laborer or payrall, payments of fringe benefits as listed In the conieeet fave bean programs fot the benef of such employees, except as noled tn Secon 4 (¢) (b) WHERE FRINGE BENEFITS ARE PAID IN GASH payroll has pad, as indicated on the payroll, pls the amout of tha required below , Each laborer or _machanle sted “In the above _ referenced an armout rot lesa en” the sum of the applicable basic hourly rate fcings onefiis as sted In the contrac, except as moled in Section 4 (c) fe) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION NOWORR WER Final Remarks: NAME AND TITLE SIGNATURE, ft exo omreen itis td jeher. SHARON MACKEY . ‘THE WILFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR oR HacoNTRAGTOR TO CIVIL OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SECTION 281 OF TITLE S1 OF THE UNITED STATES CODE. 50372 C.N. Roberta Contracting, tae. 3472 Capital circle nz ‘Tallahnese?L 32208 B0c.Sec.No HS Dep 6 Cat Hn Craft step Mama/addrase ‘wrk oate . mm, Roberts construction Certified Payroll Report w/Fringe Info Ib No apatost muren aghah of eublia Parking Oksbeesa co, Bocce Regular. ... . overtime . vous Rata tows Rate NO WORK PERFORMED ~ Page . pare - Period End - Period No. = - Other total to fre. Hoare Anieune 2 2/oa/as pafersaa 08 sss + Check petait. nesertpeion Amount _ 700-010-69 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Sonsiveuon WAGE AND HOUR RECORD Statement of Compliance: DATE January 30, 2013, (0) EXCEPTIONS a) EXCEPTION {CRAFT} ‘EXPLANATION 1 Mary Ann Scurlock {Name of signatory party) ole) do hereby state: (1) That | pay or supervise the payment of the persons employed by Gusttler & Gusttler, Ino on the FIN #O12-1998-AP (Contractor ar Subcontractor} (Bulletng or work) that during tha payrall perlod commencing onthe 20th day ot January and ending the 28h dayot “January ‘al persons employed ‘on sald project have been pald the fullweekly wages earned, that no rebates have bean or wilt be made slthar directly or Indirectly to of on behalf of said REMARKS: Guettier & Quottler, inc. from the full weekly ‘(Contractor or Subcontractor) ‘wages eamed by any person and that no deductions have been made elthar diraclly or Indirecly from the full wages eamed by any person, other than permissible deductions as defined in Regulations, Part 3 (20 CFR Subtitle A), lssued by tha Secretary of Labor under the Gopeland Act, as emended (46 Stat, 048, a3 Stal. 108, 72 Stat. 967; 76 Stat, 387; 40 U.S.C, 3146), ard desctibed belaw: FICA, Withholding Tax, Mediaare, Child Support Final [NAME AND TITLE SIGNATURE (2) That any payrolls othanwise under thls contract required to be submitted for the above period are correct end complete; thattha wage rates for laborers or mechenles contalned therein are not Mary Ann Scurlock A agli fanlab) less than the applicable wage rates contained in any wage determination Incorporated into the contract; THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE that the ofassifications set forth therein for each laborer or machanic conform with tha wark he performed, STATEMENTS MAY SUBJECT THE CONTRACTOR OR (3) That any apprenticas employed la the above period are duly registered in a bana fide SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE apprenticeship program registered with a Stale apprenticeship agency recognized by tha Bureau of SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE, Apprenticeship and Trafning, United States Department of Labor, or Ino such recognized agency exists in a Stale, are registered with the Bureau of Apprenticeship and Tralning, United Stales Department of Labor. 4) That (2) WHERE FRINGE BENEFIS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechani listed In the above referenced payroll, payments of fringe benefits as Usted tn the contract have been or wil be made to appropriate programs for the benefit af such employees, except a6 notad In Section 4(c} below. (0) WHERE FRINGE BENEFITS ARE PAID IN CASH [x] son lavorer or mechanic fisted in the above referenced payrallhas been paid, as indicated on the payrof, an amount net lass than the sumt of the applicable baste hourly wage rate plus the amount of the required fringe benefits as lstad in the contract, except ae noted in Section 4(c) below: wHse7 Wage and Hour Record: 0.0109 Construction batt Contractor's Name [ stds (fects ey a8 Payroll Number [[BOFRAT] FerWeoksting Contsat# [7] Project and Location UVF Regional Apart FINE “y (s) (8) Deductions (8) (10) Emploje0 Nero ay Ra (8) Net Wages | Tot fom and 4 Digit tentnor FER] With- | Sedieare Fatal am eld for. | Fenge Benen {@ aight 85 ana tut accross holaing Deduction ‘week Sheet equied on contraos Let |) eo tax Shost {attached prior fo 1/4/08) Examptiona / |Work Clasett| {attached} Race & Gerda itancaBush 50. XXX 871 Whita/ifale Salary 3f.00|§ 60.00|$ 7,28 $404.75 Maral Boson 99} 45.00 XXXKX-9687 Black/Malo, 10,00 sa62)$ 700] § 9.04 $495.72 Date__02/18/2013 , Sarah Harper Payroll Olerk (Name of Signatory Party} (Title) do hereby state: (1) That | pay of supervise the payment of the persons employed by Bil Smith Elactrio, inc. cathe (oahitractor oF Subechtractor) NWERA Parking Rehab j that during the payroll perlad commencing on the (Building or Work) 4 wyot 2 , 2013 and ending the 10 day of a , 2018 ail persons employed on s ald project have been pald t he full weekly wages eared, that no rebates have bean or will be made elther directly of Indirectly to or on behalf of said Bill Smith Electric, no. (Contractor or Subcontractor) ‘weekly wages earned by any person and t hat no deduc tlons hav bsen m ads althar dirsotly or indirex tly from the full wages sarned by any person, other than permlasible deductions as defined In Regulations, Part ih 3 (29 G.F.R, Subtitle A), lesuied by the Secretary af Labor uncier the Copeland Act, ae amended (48 Stat, 948, 89 Start, 108, 72 Stat, 967; 76 Stat, 367; 40 L.8.C, § 3148), and described below: fram the full (2) That any payralts otherwise under this cantraot required to be @ ubriltted for the above period are correct and complete; that the wage rates for laborers or mechanics contained thereln are not [esa than the applloabla wage rates cantalned in any wage det ermination Incorporated Int o t he c ontract; t hat t he classifications set forth therein for each laborer ar mechanio confotm with the work he performed. (3) T hat any apprent ices em ployed int heabov eperiod are duly registered In a bona fide apprenticeship progtam regis tered w Ith a St ate apprent loeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or iftno such recognized agenoy exists Ina Safe, are registered wih the Bureau of Apprenticeship and Tralning, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS Tn ection tothe basio haury waye rates pall to each laborer or mochanie stad in the above referenced payroll, payments of fringe ben fits as listed in the contract have been or willbe made to appronria ts progra ma for tha bene fit of such amployees, excapt ag noted In seotion 4(¢) nelow, (b) WHERE FRINGE BENEFITS ARE PAID IN GASH IZ] - Each laborer of mechanic listed in the above referenced payroll has bean pald, as indicated on the payrall, an amount not fess than the sum of the applicable aslo hourly wage rate plue the amount of the requlred fringe benefite as listed In the contract, except as hoted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARIG, Fur lan Nave AND TITLE Sarah Harper, Payrall Clerk aN THE WILLFUL FALEIFCATIONO FANYO FT HEAHO VEST ATEMENTSM AY SUBJ ECTT HE O NTRAGTOR O R SUBCONTRACTOR TO CIVIL. OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE, U.S. Department of Labor PAYROLL SWH Wage and Hour Division (For Contractor's Optional Usa; Sea Instructions at www.col.govividiforms/wh347instr.htm) 1S, Wago and Hobe Division Persons are not required to respond to the colleatfen of informatfon unless it displays a currently vail OMB oontrot number. Rev, Deo. 2008 MANEOrGoNTRAGTOR [] ORSURGONTRACTOR ACRES i995 Hickdan Terrace Drive ‘OMB No. 1235-0008 Bil Smith Electric, Ino, Cantonment, Fl, 32833 Expires: 04/24/2018 PAYROLLNO. FOR WEEK ENDING PROIEOT ANDIOOATION PROWBET OR CONTRAGTNG, 4 opiia/2013 NWVE Roglonel Alport Rehab Public Parking p00. Facllties, Okaloasa County 012-1988-AP ty @ @ (4) DAY AND DATE, @ @ 7 @ @ eDUSHoNs Au AND INDIMDUAL IDENTIFYING NUMBER, id ed eas 7 ws ; re (eu. LABT FOUR DIGITS OF SOCIAL SECURITY Fa work 4[sle{7[ [2 | foml eae | sir Hone | MS | Ga rom | “Se NUMBER) OF WORKER 2: CLASSIFICATION |" "HOURS WORKED EACH DAS [HOURS|__OF PAY EARNED FGA TAX, OTHER |DEDUGTIONS| FOR WEEK NO WORK PERFORMED THIS PERIOD ° FINALL ft REY ODE 8 ‘While completion of Form W047 (a optional, ta mandatary for covered contador and aubeontactors netorming work on Federal fanaed or antsed!conslvaloncantrant io reepend fo he tortion ealslan cortsned in 2 CR. 8842, fe), Tha Copaland Act (40 118.0, 9448) contractors and aubconicors performing wark on Faderaly fnanaed or zsslted conelcfor contracts to Muriah Weakly a statement wih raspeot io he wages pald asch employes dung tha precacing Week Us, Denertment of Labor (DOL) cagulatons at of Incleatg thal tha peyrolis ere carteol and complete and that cach faborer 38 GFR. §6,5(0)2)) roqura contracts ta submit weakly # copy of ei payrolls tothe Faderal ageray contacting for or finaly the oject, a igned ‘or machanio hae been nsidnotiees than the propar Devs-Eacan provalfng Wags rats forthe work performed, DOL and federal aonraating agencies rocelvig tis Informal review th infermation fo determine inal employees hav rece agally required wages andlfinge benefit, Pabite Burdon Statoment ‘Ws oatinata that fe wal lake an average of 86 minutos to completa Ils eatleeon, including tne for reviewlny ineitutons, searching existing deta souress, gathering ond maintsntng the dala naeded, and camplating andreWasing fh colscon of Itermalion. t you have ‘any comments rogarding Siose eslimsios or any olhar aapact ofthis coiscton, Intucing suggesons fr reducing tis bacon, send them io the Adimiostoter, Wage and Hour Osten, U.S. Oeperiment of Labor, Room 88502, 200 Consiuton Averwe, NK, ‘Washingion, D.C. 20210 Tver) pate___ 02/11/2013 Sarah Harper Payrail Clerk (Name of Signatory Party} {Title} do hpreby state: 4 (1) That | pay ar supervise the payment of the persons amployed by Bilt Smith Electrlo, Inc, onthe (Contractor or Subcontractor) NWFRA Parking Rehab ; that during the payroll perlod commencing on the @ulldng or Work) 2013 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH + Each laborer or mechentc listed In the above referenced payroll has baen paid, as Indicated on the payroll, an amaunt not lesa than the eum of the applicable basle hourly wage rate plue the amount of the required fringe benefits as listed! In the contract, except aa noted in saction 4(c) below, (o EXCEPTIONS EXCEPTION (GRAFT) EXPLANATION 2B ey of__1 2018 | and ancng tho 3 deyot____ 2 ail pare ans employed on @ aid project have been pald ¢