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

he full weekly wages eamed, that no rebates hays: ‘baen or will be made either directly or indlractly to or an behalf of sald BI Smith Electro, Inc. (Gantraclar oF Gubsontractor waekly wages earned by any person and t hat no dedue tons have bean m ade either directly of indirac tly trom the full wages earned by ary person, other than permissible deductions as defined in Regulations, Part 3 (29 G.F.R, Subtitle A), igsuad by tha Sactetary of Labor under the Copeland Act, as amended (48 Stat. 948, 53 Start. 108, 72 Stet, 067; 76 Stat, 267; 40 U.S.C. § 3145), and described below: FICA, Federal Withhotding, Medical Insurance from the full (2) That any payrolls otherwise under thls contract required t o be s ubmittad for the above pertod are correct and coniplate; that tha waga rates for laborers or mechanics aantalned therein ara net fas than the applicable wage rates contelned in any wage dat ermination Incorporated int at he c ontract; t hat t he classifications set forth there!n for each laborer er mechanic conform with the work he performed, (9) T het any apprent icas em ployed int he abov e period are duly registered In a bona fide apprenticashlp program regis tered with a St ate apprent Iceship agency recognized by the Bursa of Appranttceshlp and Training, United States Deparimant af Labor, or ne stich recognized agency exists In a State, are registered with the Bureau af Appranticaship and Tralring, United States Depariment of Labor. 4) That: (2) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — Inaddltion to tha baste Rourly wage rates paid to each laborar or machanic listed in the above referenced payroli, payments of fringe benefits as listed In the contract have been or willbe macle to appropria te pragra ms for thehene fit of such employees, exeapt es noted in section 4(c} below, REMARKS: Q THAME ANB TITLE Sarah Harper, Payroll Clark SONAURE THE WILLFUL”PALSIFIOATION © FANYO” FT HE ABO VE SUBCONTRACTOR TO. 31 OF THE UNITED STATES CODE. "ST ATEMENTOM AY SUB) EGTT HEOD NIRAGTORO R ‘GIVIL DR ORIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE $@ AND SECTION 291 OF TITLE U.S, Department of Labor Wage and Hour Division PAYROLL (For Contractor's Optional! Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are ‘ot required ta respond to the oolisatfon of Informatfon untess it dleplays @ currently valid OMB aontre! number * US, Wage and Hour Division Rev. Deo, 2008 i NE OP CONTRACTOR FJ ORSURGONTRAGTOR FZ] RDDREES 1996 Hieddan Terrace Drive ‘OMB Now 1236-0008 Bill Smith Elect, Ino, Gantanmant, FL 32593 Expires: “01/31/2016 PAYRORL NO. FOR WEEK ENDING PROWEDT ANOLOOATION FRSIEGTOR CONTRASTING, 02/08/2018 NWE Raglonal Airport Rehab Public Parking ' Facilities, Okaloosa County G42r4990-AP a 2) a TH OAV AND BATE @] @ a y @ Ye elulaTwimlelsTs veoultions we AKO NDMAOLAL oeAmIeeNeNoWBcR |, BE i onaes we wees toa, ther rouR aS oF sel secuRTY 429 work el] [2[31]1 [2] 3 bom) rare | Siete wane] 5 | Gate, Tom | MASE NUMBER) OF WORKER 2 CLABBIFICATION, HOUR: RED EACH DA ours! OF PAY EARNED Flog, TAX Z ‘OTHER _|DEDUGTIONS| FOR WEEK ‘Travis Tucker 4377 Blecttclan [fo 410 1 sis.az | $0200 | $3689 stasas | s4eias | 200 2.00} 1108 Loas0 a 3 ‘ a ° 3 . ° 8 3 3 ° 2 ° . fata eration alelonconid 7 G 44.8, So The Gopeiend act ‘Wille completion of Form WiH-247 Is aptona, its mandatory fr oavered eantraclors and subeaniracirs performing werk an Federaly ¢nanasd or assisted construction canlanls 40.U.5..5 9148) eantractors and subconractora performing work on Federally tharced or eesletod consti carirecis i umish Waekly q sis'gment th rsapoct to ths wagee pal aaah employee dug ihe praneding Week.’ U.S, Depertment of Labor (ODL) regulalions at 2ECFLR, 8 6.6{9}(9)(l) raqule contractors o aubmik weakly a napy of sl payratis a ha Fadaral aganey conlrantng for 9 the construellon prolect, accompa by & signed "Statement oF 2" Inicang that tha payrolls are cartact and oompisie al that oat laborer formachenlo has baen Pald not less then the proper Cavis-Bacon prevaling wags rate for the work performed, DOL and federal contrating agencies racaiving the Information ravley the Informa fo datecmine that employees have reoelved lagaly required wogek anc hinge benefit, Putite Burdon Statoment ‘Wo eatimate that few take an average of 66 minutes to completa this eolactio, Including fn far reviewing Inattutions, searcshy exetng data sources, gathering and maintaling the sala needed, and campleting and vevawing the collection af information, Hf youhave ‘any comments regarcng these esimatss or ary other aspect ofthis colscio, Inoluting sungasons for ducing ths burden, send them ts the Adminleeelor, Weg and Hour Dkisien, US, Department of Labor, Room 83602, 200 Gonatiuan Avonue, NV, ‘wushinglon, 0.0. 20210 Teva