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

PROJECT AND LOCATION PROJEGT OR CONTRAGT NO, 38 1212812012 NWF Regional Alrnort Rehab Publie Parking 1990. | 2 Faolilles, Okaloosa County 012-1930-AP s @ ro) 14) DAY AND DATE ry oy ri) o ® E elu] [w pm eps [s agoUShons ve [NAME AND INOMIDUAL IDENTIFYING NUMBER 8 8 wn WAGES (og, LASTFOUR DIGITS OF SociAL seouRITY [8 iq WORK gL 27 [te fisf mp2) 22 [25 fora! are Bags oiene | NEE | jean Tora | AGE NUMBER) OF WORKER 2 CLASSIFICATION (OURS WORKED EACHDAYMOURS| OF PAY EARNED FICA TAX “ OTHER DEDUCTIONS! FOR WEEK. Travis Tucker 4377 Blactician fo 534.10 1 $24.76 | $40.00 | $36.83 sio1ss | $373.51 8 2a 2,00 | i705 5475.10 Henry Black 1416 Electrician ° [885.25 1 $14.19 | $19.00 | $46.57 379.76 | s2i7a9 198 : * 5.00 $297.75 Brian Anderson 8788 Goneral a $367.50 0 Laborer 322,88 | $46.00 $08.88 | $336.12 s a 5.00} 1350 ‘405.00 ° ‘ o 5 0 A ° 2 o 2 sisted constuction contracts to 32 information colfacian contained in 29 C.F. 8.5, .6(0) The Copaland Aat ‘While completion of Form W847 If pon, tts mandaloy Tor covered aonlrsctore and subaantastors performing wark on Federally tnanced. ‘a {40US.C, § 9148) contractors and subcontractors performing work on Federally nari or essleted constunton contracts ta Numieh weekly a atelamant wih regpact lo the wages pal #ach employee during the preceding Week" U.S, Qapariment of Labor (DOL) raqdalons at OG. § 6.8¢8(3)() raquite conttactra to submit weakly a copy ofall payrols lo the Fedora agency conirectng far of financing the: reject, bya signa’ of Inacating thatthe psyzlls are corrat and complete and that each laborar ‘of mechani has been pald not fees than the proper Qevis-Becon pravaling Wage rete for tha work performed. DOL and ledorel ‘agencies recol¥ving thle review te: fo determine al smployaes have recelved[apally required wages and fringe benefits. Publa Gurden Statement ‘We eatleate that le wil feke an evarage af 85 minutes to completa this election, fneludhng tine for reviauing Intuctlons, searching exstng data sources, gathering and malnaing tha data ended, ond complang end reviewing the collection of nfarmalion you have ny carnments regarding these eimates or any other aepect of ihe callcton, Including auggeations for reducing this burden, send (hom io the Administer, Wage ane! Hout Bivllen, US. Deparment of Labor, Room $9602, 200 Consilsion Avenue, NAN. Washington, D.C. 20210, (every Date 1424/2012 Saran Harper Payroll Clerk (Name of Signatory Party) Titley do hereby state: (1) That | pay or supervise the payment of the persons employed by {b) WHERE FRINGE BENEFITS ARE PAID IN CASH [Z] — Each laborer or mechanic Ulatad In the above referenced payroll has been pald, as Indloeted on the payroll, an amount not fess than the sur of the applicable basla hourly wage rate plus tha amount of the required fringe benefits as ilsted in the contract, except aa noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Bill Sralth Electra, Ino, onthe ‘(Canfratior or Subcantractor) NWFRA Parking Rehab } that during the payroll period cammencing on the ‘Building or Work) 10 aayor 42 , 2012 | andending the 16 day of 12 , 2012 all parsons employed on s ald project have been pald the full waekly wages eamed, that no rebates have been or will be made elther alraoty or Indlracty to or on behalf of said Bill Smith Electric, Ino. ‘Goniractor or Subcontractor) weekly wages earned by any pereon and t hat no deduc tions have been m ads either directly or indires tly from the full wages earned by any perean, other than permissible daductions ae defined in Regulations, Part 320 CFR, Suntte A, ised by he Secretary of Labor under the Copeland Ac, es amended (48 Sit 48, 63 Start. 108, 72 Stat. 957; 76 Stat. 387; 40 U.8.C. § 3148), and described below: FICA, Federal Withholding, Medical insurance from the fuli (2) That any payrails atherwise under this contract required to be s ubmitted for the above period are correct and complate; that the wage rates for leborers or mechanics cantalned therein are not less than the applicable wage rates contained fn any wags det ermination incorporated int of hes ontract; t hat he: Classifications set forth thereln for each laborer or mechanic conform with the work he perfarmed, (3) T hat any spprent leas em ployed int heaboy e period are duly registered In a bone fide apprenticeship program ragls tered witha St ate apprent losship agancy recognized by the Bureau of Apprenticeship and Tralning, United States Department of Labor, or fro such recognized agency exists in a State, are registered with the Bureau of Apprenticeship end Tralning, United States Department of Labor, (4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS Dn action tthe basis hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or willbe made to appropria te pragra ms for the bene fit af auch employees, except as noted In section 4(c) below, REMARKS: NanE AND TITLE Sarah Harper, Peyroll Clerk The HULL FALERICITIONS FAR. Fy Recaa Veet RTEMENTSN AYSURY ECYT TEGO RFRAGT RAGTOR Te G¥VLLORGRIMBIAL PROSEEINION EE SEUTION ToD! OF TLE 1bAND SECTION G91 OF THLE DE. JBOONTRA SLOPTHE UNTEO STateo GO * U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.goviwhdiforma/wh347ingtr.htm) US, Wage and Hove Division Parsons are not required ta respond to the coltectfon of information unless it displays @ currently valid OME contra! number. Rev, Dac, 2008 NAME OF CONTRACTOR [] __ ORSUBCONTRAGTOR P7] ADDRESS 4998 Hidden Terrace Drlve ‘OMB No.; 1235-0008 Bil Smith Elsctrla, Inc, Cantonment, FL 32533 Expires: 01/31/2015, PAYROLL NO, FOR WEEK ENDING PROJECT AND LOCATION pati PROJECT OR CONTRACT NO, 37 42/46/2012 NWF Reglonel Almort Rehab Publle Parking 19805 Feotities, Okaloosa County 012-1999-AP ah a & (4) DAY AND DATE [oF {8} ray @ [oy ke elm] t[w]m]F] 8 [8 DEDUCTIONS et awe ANBINDWIOUAL DenFvino NUMER | Hl a - wile (63, LAST FOUR Dias OF SOOIAL SECURITY A wou leltefufie]isfis[ is [6 bron! are | roan wouane | ME | cD. ror. | pan NUMBER) OF WORKER g CLASSIFICATION DURE WORMED ECHO Hours] _ovpay_| Earwen | rica |" tax comer _[oeoucrions| ror werk NO WORK PERFORMED THIS PERIOD Cy ° ° * o 5 ° 3 ° . ° 8 o ‘ a 3 (Tha Copeland Act ly inenced o” slated construction contrac (9 raspand {otha Information collecilon contained in 28 O.F.R. 85.2.3, Turnish weekly a slalamant wit respect (othe Weges pald each employee diving tha preceding weak,” ULB, Department af Lebor (00L) ragulatlane a gned "Stetemant of Compllence" indicating that (ha payrols are carat and asmpsa and thal each labaror few te infonmaton to determine that amployses have recalvad iagaly required wages and frnge berets, While completion of Farm WH-347 Is optonst, its mandatory for noverad contractors and suboontractae performing work on Fe (40.U.8.C, § 4148) contractor and subcontractors partorming work on Federally iranced or aeslstad eenatuatfon contrac 2B CR, § 5.8(6)(}n requis contractors fe aubrll weekly a copy af el payrals lo the Federal agency: far oF ancing the: projet, by ‘or mtechanis has been pele not ese than he proper Davie-Bacon pravaflng wags cats fo the work gerfarmed, CO and federal contracting agencies rsceling Ha infomation Publte Bardon Ststamont {Ws estimate that le wil fake en average of 85 minutes to compte hs collcton,Incusing time for reviewing nerualons, seerching existing dale sources, geihating and mafniarig the data needed, and completing end ravlawing {he eallectan of information. Hfyou have ary comments regarding these estimates or any other aspect of tis celleeon, Including suggestions for reducing iis burden, and thom to the Adminisiretar, Wage and Hour Ohislon, U.S. Oopertmant at Labor, Room 88602, 200 Constutton Avan, NW. ‘Wostingion, D.C. 20210 co) STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: 700-010-689 Construction 02/11 DATE November 28, 2012. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION \ Mary Ann Scurlock (Name of signatory party) Title) do hereby state: (1) That | pay or aupervise the payment of lhe persons emptoyed by Guettier & Gueller, Inc. an the FIN #012-1030-AP (Contractor or Subcantractor) (Buliding or work) ‘hat during the payroll perfod commencing an the 48th dayof November and ending the 24th deyof “November ‘all persons emplayed ‘on said project have been paid the full weekly wages earned, that no rebates hava been or will ‘be mada elther directly or indirectly to or on behalf of salt REMARKS: Guettler & Guattler, ino. {rom the full weekly (Contractor or Subcontractor) Wages eamed by any person end that no deductions have been made slther directly or indirectly from the (ull wages esmed by any person, other than permissible deduetions as defined In Regulations, Part $ (29 CR Sublite A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat, 948, 69 Stat, 108, 72 Stat, 967; 78 Slat. 257; 40 U.S.C, 3145), and deseribad below: FICA, Withholding Tax, Medicare, Chil! Support INO WORK NAME AND TITLE. SIGNATURE (2) That any payrolls otherwise under this contract requlred fo be submitted for the above perlod are correct anid complete; that the wage rates for laborer’ or mechanics containad therein are not fase than the ‘wage rates conlained in any wage determination Incorporated Inlo the contract, that the classifications set forth therein for eftch laborer or mechanic conform with the work he performed. {8} Thal any apprentices employed In tha above period are duly registered in a bona fide apprenticeship program registered with a State apprentteashlp agency recognized by the Bureau of Apprenticeship and Training, United Statss Department of Labor, or if no such recognized agency exists, ina State, are registered with the Bureau of Apprantioaship and Training, United States Departmant of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In adeition to tha basic hourly wage rates pald to each laborer or machanic listed In the above referenced payroll, payments of fringe benefits ae sted in the contract have been or will be made to appropriate programs for the benefit of such employees, except as notad In Section 4(c) balow. (o) WHERE FRINGE BENEFITS ARE PAID IN CASH ra [Each laborer or mecheinic isted In the above referenced payroll has been Paid, as Indicated on the payral, an smount not less than the aum of the applicable basle hourly wage rale plus the amount of the required fringe benefits as fisted in the conlract, except ae noted in Section 4(c) below. Mary Ann Scurlock Yh Bre hunloct—| THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE ISTATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE| SECTION 1001 OF TITLE 18 AND SECTION 234 OF TITLE 31 OF THE UNITED STATES CODE. 7o0.050.88 waradr Consiveian oat Wage and Hour Recor j } asses [Een NNT Contractor's Name i ‘Qusttlor & Gueitlet, Ine. Payroll Number: [307 Forweersnang —[ Wavemnbor 24, 2042 ] Contract # | Project and Locatton FINS i a) a 77 (8) Deductions @ Tio) expels (Bayend ate TE) Yon] woe | a i and 4 Digit Ideatiner on | Tues waa] Tara a] Hours Grose | Medicare Fal a Pald for. | Fringe Bonott {9 digit 88 and fu aderase 4 et on Tuned ers) Eset holding Deduction | Deductions | “Weck 4 roquired on contracts Let a @ iF Gross tax ‘ghaat {attacheay prior te 149100) | Exampttona# [Work Cragslt, {attached) lita W, Tayror 80 lo 0.00 | ei aVALUEL [XXXXX-9998 White/Male Foreman |S 0,00 Salary $0.06 = Ryan Gray Meo lo o.oo _| atvemel #vALUEI |XXX-XX0827_ WhiteMate Foreman iS 0.00 Salary $0.00] $ ~ clinan Golden 34 lo 0.00__|annuawel evaLuel roen.nn.742a wirwentato| Foreman |S 9.00 __| Salary $o.00|$_ ra Taytor 39 yrpactin 90 | 21.00 | 9.00 abet AXX-XX7 268 ‘Striping_|s. 9,00 44.00 $0.00) $ ~ iartel Obs0n 22] om lo 00 | 16.00