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

laborer or payrol, payments of fringe benols as listed Inthe contact have been or wil ba programs for the benef of such amplayeas, except aa noted in Sacton 4 (c) below OR PROGRAMS mechanla listed In the aboye referenced made fo appropiate (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Oo Zach ‘laborer of mechanised In the abova referenced payroll fas paid, as _Indlested on the payroll an amout not’ tess than the eum of tre apploable haste hourly rato plus the amout of the requted finge ‘benefts aa isted in tho conbacl, except as noted in Sactoa 4 (c) below. (0) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION NO WORK Romarks : NAME AND TITLE SIGNATURE SHARON MAGKEY » SEO OFFICER, THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR 5 Ggconraactor To CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. 56372 c. W, Roberta Construction cereitied Payroll Report w/Feioge Info cu, Roberta contracting, rae. 3372 Capital circle me ‘TallahasseF 32308 Bor.ser.tlo FNS Dep & Cet Mn Name/Address Job Nos: as11001 WHER fAahab af Public Parking Gkatvoga Co. OCC crace step - Regular. . .. . Overtime. . Other rk Date flows Rate Moura Pate NO HORK PERYORHED Page Dace Period end Period No. Total gob Hours Anon : 60 = aa/is/a2 + afs/sa : as . hack DetadL. ‘Amount: Deseription Fringe penetiti Date - 12/20/12 66373 ot SYATEMENT OF COMPLIANCE oll SHARON MACKEY ,EBEO OFFICER do hereby atate: (1) That 1 pay or supervise the payment of the persona employed by C. W. Roberta Contracting, Inc on tha (oullding or Work} NWFRA Rehab of Public Parking Okaloosa Co. BOCC that during the payroll period 12/17/12 - 12/23/12 ; all parsons employed on said project have bean paid the full weekly wages earned, that no rebates have been or will be made elener directly ox indirectly to or on behalf of said {Contractor or Subcontractor) ¢, Mt, Roberts Contracting, Ine fron the full waskly wages earned by any parson, and that no deductions have been made either directly or indizectly from the full wages earned by person, other than perniesible daductiona as defined in Reguiatione Part 3(29 CFR Subtitle A), ieaued by Secretary of Labor under the Copeland Act, as amended (48 Stat. 948:63 Stat. 100:72 Stat, 967:76 Stat, 357:40 U.S.C 3445}, and described below: Doan #1 ) bife - AFLAC, Child Supp#l , Uniforms ) Overpayment —, ABLAC-Cancer , Fortds-entl AFLAC-Dental ; advance + BELAC-Hosp + AFLAC-S1D + RELAC > Rith-@-cmR + HLGh-F-CHR ' With-Ec-cwe | HIth-ES-cuR 401K CHR + ban #2 + Mise : (2) That any payrolls otherwise under this contract required to be submitted for the above period ara correct and complete; That the wage rates for laborer and mechanics contained therein are not less than the applicable wage ratea contained in any wage determination incorporated inte the contzact) that the classification set forth for each laborer or mechanic conform with tha work perforned {2} That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognizad by the Bureau of Apprenticeship and Training, United States Departuent of Labor, or if no such recognized agency axiate in a State, are ragistarsd with the Bureau of Apprenticeship and Training, United States Department of Labor. (a) Mat: (a) @HERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAME | tn addition to the basic hourly wage rates paid to each laborer or mechanic Listed in the above referenced cs-+ payroll, paymenta of fringa benefits ad listed in the contract have been or will be made to appropriate programa for the benefit of euch employaes, except as noted in Section 4{c} below. ++ GEE ATTACHED BENEFIT SHEET *+ (b) WHERE FRING! BENSPTTS ARE PAID iN CASH | | Sach Laborer éy mechanic Listed in the above referenced payroll has been paid, as indicated on the payroll, ap auount not lea# thaa the sum of the applicable basic hourly rate plus the amount af the required fringe benefits as Listed in the contract, excapt as noted in Sectiond{e) below. (a) EXCEBTIONS (CRAFT) EXCEPTION BXPLANATION Remark NAME AND TITLE SHAROW MACKEY VEO OFFICER ‘THE MILLPUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 19 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. 86372 ©. W. Roberts Construction cextitied payroll Report w/Pringa Tato GH. Roberts Contracting, Te. 3372 Capital cirele ME Yallahasee?t 32308 0b He. astio41 sRA Hehab of Public Racking Okaleona do. Bocce Soc-See.No MS Dep S Cat Ma Graft step Regular, ., Overtime. ‘Mane/nddress ‘rk nate Hours Rate’ Hours Rate YURHN-ESST § LM 008 02 SD Felito &, Alkamirano wang unskilled Laborer (General) Male Hispanic or Latino Altamirano, Felito 1. NEK-KX-1022 «M008 01 2030 Adam R, CALE wana 9.50 31,580 Asphalt Screed operator 3.50 Male white (sot of Htepania cider, adam R, ARXMK-32L7 WLM oud ot Soto Christopher 8. Davie aafar/az a.00 22.500 Superintendent 3.00 Male White (Not of aispenie Davis, Christopher $, TaxmK-8043 He G08 01 So page . 8 pate + anfao/i2 Period and - 12/23/12 Period a. - 3 + Other Total We we ire, Hours Anount_“Dagcription 10.00 e760 Gross pay FED Taccma T FED LCA w/a FED Medicare ules - chm Nee ray 27.50 10.00 87.50 97.50 108.73 Gross Pay FED Income T PED PICA w/t FEO Medicare Leh-Ee-CoR Aabantal & H Life ~ APLAC nt forms nee Fay 309.73 Gross Pay PED Income T FED FTCA w/h FED vedicare Aith-F-cwR AFLAC-87D $018 GAR RTH wR 40L4R OF Not Pay = Check Deval. ‘avon 346708 536.25 62.41, eer 2.80 2182 450-10 anes 273.00 1.00 ania Frere 60.00 5.66 B.12 (oo 61.60 ena? 1,078.00 9746 ange 143 88.00 734 38.00 18.00 118.39 vrtnge senefit & 04 ($1ewees 80) 56272 C. W, Robart Construction Certified payroll Report w/Fringe Tate GoM. Roberta Contracting, tne. 337% Capital Circle NE ‘Tallunagee?l 32208 ob to. asian WHeRA Rehab Of eublie Parking Okakgeea Co, nace Soc-dee.No YMs ben $ Cat Hn Craft step =» Regular, Nane/adéress rk Dave Hows Rate Hours Bidunboth b. Galld apna Unskitied taborer (General) 19,00, Fouala White {Hot of Hispanic Galli, ¥liaabeth b, woOeRE-2324 M008 03 0 Matilde . Palacios aastiaa 10,00 9.500 Male Hlapanic or atin 40,00 Unskilied uaborer (General) Palacios, Matilde §. 10,00 XMCKK-3600 6 1M 008 03 1140 Gregoria %. Rodriguez saftr/az 10.00 29.090 Loader Opazator 0,00 wale aiepante or tatino 39.00 Rofeiguaz, Gragorio A. 40.00 RXE-KE5I9] 8 2M 907 OF 2030 Tertery 1, sheets aasuriaa 4.50 12.190 Lowboy ‘Truck Driver 1.50 Male white ot of Kispanie overtine . Page : a Date = an/ao/ia Period und - 12/23/32 Peried No. * 03 other | total goo wird. fours AouNt —“bawertpt ion as.oa 120,00 Grogo ray 40-00 420,00 FAD Income FED ICR w/a P50 Medicare Net ray 10.00 120.00 10.00 120,00 1.00 98.00 rots Pay 10.00 95,00 FED Inoone FED PICA w/t Fe wedicare anDental & Uniforms Ret Pay 10.00 (98,00, 10,00 98.00, 10.00 10.00 : = Gzoae Pay 2b.00 100,00 Fan Income 7 FED FEA w/h FED Medleare RLER-HocuR Wat Poy 100.09 20,00 100.00 aso an.as Gross Fay 2.80 18.29 ED Income T FED FICA ¥/h emo Medicare Nat eny 150 18.29 ++ Cheek Dabad. ‘noun: 43290 400.00 52.42 20.16 5.96 400.48 sane 638,50 54.53 26.80 pens 5166 3.00 597.87 93232 on.76 70159 26.91 9.29 32.00 533.97 exang 996.35 00.37 37.86 32137 74348 Feinge benefits 56372 Cc. . Roherte Construction certified Payroll Report w/eringe Info Cum, Roberts Contracting, Ino. 3372 Capital Circle NE ‘Tallahapser, 22308 Job Ho.1 asni04 AWiPRA Rehab) Of Public Parking Okalocea Ca. HOCC = Regular. . Rate "Hours Boc.dec,Na FHS Dep S cat Hn Crafe step : fours Wek pate ‘Name/addroes Bheeta, gettery b. 4 006 on atx0 aapnaa XC HK-4003 Donald &, Tate 30.825 seme aria oesstor lade Male White (Not of Hispanic vate, nenala 8. 8,00 wigea Rehab of Public Parking overtice page - 4s pate + ayaonz Period und - 12/23/32 peried No. + 03 oxner Rate ra total weurs Description aso 18.33 248.00 rows Pay Pep Tncone 7 ep PICA w/h Feo Nedicare Bitn-F-cmn APLAC-OPRVE ‘ApLAG-Dental a.0@ 245,00 Nat Pay 8.00 248.00 a.00 245,00 955.52 = check petail. ‘angunt. orzaa 1,380.00 a4s.62 52.26 ar 8.00 3a 32.03 fers 6.78 anor 43,00 sas.1¢ Fringe Banetive-- Davis Bacon Employee Wage Rate and Fringe Benefits Statement Certified Payroll End Date: 42/23/2012 Project: NVV/FRA Rehab of Public Parking FPN # County: Okaloosa Employee Name: Adam Clift Hire Date: 41/14/2011 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. Plan | Vacation| Holiday| Paid For Classif.|Raie Rate |Fringe| See #1 | See #2 | See#3 | See#4 | See #5 | Fringe Fringe Screed Operator $10.75 1$11.59] $0.00 | $0.00 $0.00 $0.04 $0.04 $0.80 Overtime Hourly Rate $11.59 Overtime Hourly Rate X 1.5 $17,39 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. (vi; | Coverage [NA $0 $0 2080 173.33 $0.00 Life Ins. (# 2) 2080 173.33 $0.00 401K Plan (#3) Unfunded Frin:.. Benefit Calculations fu; :iourly Pay Employee Paid Hours times | Annual Value (Annual Value / Rate Paid Days Hourly Rate Hourly Rate Annua! Standard Hours} Paid Vacation |. 4) 0 $10.75 $0.00 $0.00 Paid Persona: . i 5) 1 $10.75 $86.00 $0.04 Davis Bacon Employee Wage Rate and Fringe Benefits Statement Certified Payroll End Date: 12/23/2012 Project: NWFRA Rehab of Public Parking FPN # County: Okaloosa Employee Name: Gregorio Rodriguez Hire Date: 4/19/2006 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. Plan | Vacation| Holiday} Paid For Classif. Rate Rate |Fringe| See #1 | See #2 | See#3 | See#4 | See #5 | Fringe Fringe Loader Operator $10.00 [$10.23] $0.00 | $1.83 $0.58 $0.23 $2.64 $0.00 Overtime Hourly Rate $10.23 Overtime Hourly Rate X 1.5 $15.35 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 E $455.57 $316.90 2080 173.33 $1.83 Life Ins. (# 2) 2080 173.33 $0,00 407K 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) 15 $10.00 $1,200.00 $0.58 Paid Personal (i# 5) 6 $10,00 $480.00 $0.23 Davis Bacon Employee Wage Rate and Fringe Benefits Statement Certified Payroll End Date: 12/23/2012 Project: NWFRA 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. (# 4} 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 STATEMENT OF COMPLIANCE Thee 1 ggARON MACKEY ($20