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

| 909 roenerat exxocx087 tavorar_|s .90__| 10.00 $0.09 $ [vmnbur Briningor 84. o on lo 9.00__| 20.28 | 9,09 Machine RXX-XX-0840_ WhiterMale | Nezzlemen |s. o.oo | 43.50 $0,00| § = coty Davie, 5 opietaing (@ ooo | 2138 | 9.09 Machine Lox xnatt wintemmate| Operator [3 o.oo | 14.26 go0os Msoseph Bla, ir sad ay lo ooo _| 18,00 | 0,00 : ‘aanaral XXX-XX-9846 White/Male_ Laborer_|3. 0.00 10.00 $0.00] $ - faustin whinngion so) ay lo 000] 48.001 990 ‘1Generat XXX-XK-7044 Whitefhtale_ Laboror_|S 0.00 19,00 $0.00) $ lly Thiet 80) ay lo ooo | 47.28 | 900 1General xxx-xx4236 Wnutensete| _Laboror_|s 0.90 | 14.50 30.00] § fason Leatherwood we! lo ogo | 1.00 | 900 WGeneral PKK L697. Wailo/tiato, Laborer {5 0,00 10.00 $0.00] $ = {o) WHERE FRINGE BENEFITS ARE PAID.IN CASH TZ] -. ech laborer or mechanic listed In the above referenced payroll has baen pald, ae Indicaled on tha payroll, an amount not less than ihe sum of the applicable basle hourly wage rate plus the amount of the requires fringe benefits as listed in the contract, excepl as nolad In section 4(c} below. {c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Date 42/6 ‘ Allison M Clark Secretary (Name of Signatory Pariy) Titiey do hereby stala; (1) That | pay or supervise tha payment of the parsons employed by INTEGRATED SYSTEMS OF FLORIDA, INC. onthe ‘(Contractor or Subcontractor) NWEL REGIONAL AIRPORT PKNG LOT REN that during the payroll perlod com 1g on the (Bulfding or Work) 25 caval 1 2012 | andendingths__1 day of. 12 2012 | all persons emplayad on sald project have been pald the full weekly wages earned, that 10 rebales have heen of wil ba made aither direclly or Indirectly to or on behalf of sald INTEGRATED SYSTEMS OF FLORIDA, INC. ‘(Contractor ar Subcontractor} weekly wages eatnad by any person and that no deductions hava baen made elther directly or Indlractly from the full wages eamed by any person, other then permissible deductions as defined In Regulations, Part 3 (28 OF.R. Subtle A), lasted by the Secretary of Labor under the Copeland Act, as amended (48 Stal. 948, 83 Slart. 108, 72 Slat. 867; 78 Stat, 387; 40 U.S.C. § 3145), and described below: Federal Withholding, FICA, and Insurance from the full {2} That any payrolls otherwise under this contract requtrad lo be submitted for the above period ara correct and complats; that the wage rales for laborers or machanles contalned therein are not fess (han the wage ratae In any wage a nto the contract; thal the classifications set forth therein for each laborer or mechanic conform with tha work he performed. (3} That any epprentices employed In the above period aro duly registered in a bona fide apprenticeship pragram registered with a State apprenticeship agency recognized by the Bureau of Appraniiceship and Training, United Slates Department of Labor, or if na euch recognized agency exisls ina State, are registered with the Buresu af Apprenticeship and Training, United States Department of Labor. (4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: Ty _ in action to the basic hourly wage rales pald to each laborer or machanio stad in the sbove refersnesd payroll, payments of fringe benefits as feled In tha contract have been or wil be made to appropdate programe for the beneft of such employees, except as noted [n sacllon 4(c) below. REMARS 5 Nag AND TITLE Sian gTaR ALLISON M CLARK Ws SECRETARY GA T THe CONTRACTOR OF THE WILFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS NAY SUBIC! SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 16 Ah 3LOF THE UNITED STATES CODE, NU BEGTION 23 OF TITLE U.S, Départment of Labor PAYROLL Wage and Hour Givision (For Contractar's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) US, Wage and Hour Divston Rev, Dec, 2008 Persons are not reqiited to respond to the cotfaction of information unless it displays a currently valid OMB control number. Nave OF CONTRACTOR [>] OR SUBCONTRACTOR ABDRESS 59 SCARLET BLVD, OLDSMAR, FL 34677 | OW Nox 1218-0149 ° " it INTEGRATED SYSTEMS OF FLORIDA, ING. xpltes! 12/31 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 32 s2/o4ye012 NWFL REGIONAL AIRPORT PKNG LOT RENO ora a) (2) a (4) DAY AND CATE. (8) (6) a ~ (8 EOUCTIONS i e] s[MiT|w[ TF] s ° ner ANE AND INDIMDUAL IDENTIEYING NuMBER | a wie WAGES wa-usvrounpersorsooareeciary [888] wom felas[ze{a7]es] 2] | 1 oral nme | Sheet ate be vom | Ye NUMBER) OF WORKER 258] cusapicaron HOURSWORKEDEACHERY—Wours| orray | EARNED | FicA | “THX omer [penucrions| ror week © ‘ BADALATY, TROY 305-998-5662 ELECTRICIAN Jo, $34.50 2926 HILLSIDE RAMBLE DR 2 ssa.is | 311620 szis.cs | s40597 | 361036 BRANDON, FL 93611 : a 1.50] 20 $1,016.33 ‘$639.38 MADDOX, JEFFREY W 255-49-3501 GENERAL fo $25.58 10459 ROSE RD 0 LABOR sag.o4 | $84.50 sisiad | 3699.19 TALLAHASSEE, FL 92311 8 2s0 | eon} 1900] 220] $00 37.5() 10s $230.63 > s a 8 ° ° o s o s (a), The Copeland Act ‘tontactors and subrcentrasors peiforning wark an Federally nanced or atsleed consirucion contracts fa respond to he infomation coieclon eartelned In 28 GFR. §§ 3.2, § (a), The Gopeland (OU. § 0146) corrector and subcanracirs perfaming work on Fadaraly financed of acisted consiniction corracs ta "umnish Weak’y a Eatemont wih respect otha wages patd aach emplayeo dung the. precading weak” U8. Dapariment of Labor {DOL} requlallons at 20.G.F.R.§ 5.5{OX9XU) requita contracirs to submn weatly 3 copy o al payrls ta the Federal agency for or incing the: Projet, ed by «signed f > Ingleating thel the payrols are carruct and complele and that each laborer or mechanic haa ben ped nat ess han the proper Davis acon prevailing waye rae fof th werk pectormad, DOL and federal conkacting agenelesreceing this informllon rasiow he information ta delenninetl employees have received legally requlad vages and fringo bane \ihitp campletion of Form Wii-347 Is optional, Wis mandatory for covered Putite Burden Statement Hn for raviowing asivucllons, searching exiting data sources, altering pnd maintaining tha dala naeied, and complting and reviewing tha collation of Information. {you hava ‘We estimate that Is wif laka an avarage of $6 routes ta complete this collation includ send them la tie Administalor, Wags and Hour Division, US, Dapartmant of Latar, Room 83502, 200 Gonsituton Avenue, NW. ny conirnant regarding Inese estimates or any olher aspael of Lis calleelon, nckuding suggestions for radicing thls burden, Washingten, 0.0, 20240 11/28 Date (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Allison M Clark Secretar 4 id [2] = Each laborer or mechanla fisted In the above referenced payrall has been pald, (Name of Signatory Party) (ite) a8 indicated on the payroll, an amount not lass than the sum of the applicable yt do hereby state: basic hourly wage rats plus the amaunt of the requlred fringe benafls as sted : In the contract, except as noled In saclion 4(o) below. (1) That | pay or supervise the payment of the persons employed by c) EXCEPTIONS INTEGRATED SYSTEMS OF FLORIDA, INC. an the 2 (Contractor or Siboontractory EXCEPTION (CRAFT) EXPLANATION NWFL REGIONAL AIRPORT PKNG LOT REN ; that during the payroll period commeneing on the ‘(Guitding or Worky 18 ayof “1 » 2012 | and ending the__24 day of uu 2012 all persons employed on sald project have bean pald the full weekly wages eared, that no rebates hava been or will be made elther directly or indirectly to or on behalf of sald INTEGRATED SYSTEMS OF FLORIDA, INC. Contractor or Subcontractor) from the full weekly wages earned by any parson and that no deductions have heen made elther directly or indireclly from the full wagas earned by any person, ather than permissibia deductions as defined in Regulations, Part 3 (20 C.F.R, Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat, 948, 63 Slart, 108, 72 Stat. 867; 76 Stat, 357; 40 U.S.C, § 3148), and described below: Federal Withholding, FICA, and Insurance (2) That any payrolis othervise under thls contract required to be submitted for tha abave period are correct and complete; that the wage rates for laborers or mechanics contained theraln ara nat less than the wage ratea In any wage determination incorp Into the that the classlications set forth therein far each laborer or machanic conform wilh the work he parformed. (@) That any apprentices employed In the above period are duly registered In a bona fide apprenticeship program registered with a State appranticashlp agency recognized by the Bureau of Apprenticeship and Training, United States Ospartment of Labor, or If no such racagnized agency exists in a State, are registered wlth the Bureau of Apprenticeship and Training, United States Department of Labor, [ (4) That: ‘ (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS NAME ANO TITLE siayhtoRe 77 77: yj g ALLISON M CLARK, f yy f lif po— — In addition to the basic hourly wage rates paid to each laborer or mechanic listed in SECRETARY acy, the above referenced payroll, payments of fringe benefits as lisled in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUINECT THE CONTRACTOR OR have been or will be made to eppropriate programs for the benefl of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 QF THE UNITED STATES CODE. employees, except as noted In section 4(c) belaw. U.S. Department of Labor PAYROLL H Wage and Hour Division (For Contractor’s Optional Use; See Instructions at www.dol.gov/whdiforms/wh347instr.htm) USS, Wage and Hour Ditilon Persons are not required to respond to the colfection of information unless it displays a currently valid OMB contra! number, Rav. Dea, 2008 NAME OF CONTRAOTOR ["] OR SUBCONTRACTOR [yj ADDRESS 489 SCARLET BLVD, OLDSMAR, FL 34677 OMB No.: 1215-0149 Expires; 12/31/2014 INTEGRATED SYSTEMS OF FLORIDA, ING. PROJECT AND LOCATION ‘PROJECT OR GONTRAGT NO, PAYROLL NO. FOR WEEK ENOING Hn sWyeanoor2 NWFL REGIONAL AIRPORT PKNG LOT RENO ovr tH @ ry (OAV AND DATE ® @ tr © o # Ks[™[7 wa] FIs DEOUETIONS va NAME ANO INDIVIDUAL IDENTIFYING NUMBER 5 ross rag wages cnuerromparearsoenseauy [8h wor fe 8] [20] a1 [22] [26 lo pare | SESS ena bap rora, | “oe UNGER) OF WORKER 250] c.assiricarion TOURS WORKED EAGITSAY—MouRs oF pay {| earned | Fica_| TAK coger _[oeouerions| ror weex ° s BADALATY, TROY 205-98-5662 ELECTRICIAN jo $420.00 2026 HILLSIDE RAMBLE DR 2 $53.45 | $113.23 $235.66 | $402.34 | $602.11 BRANDON, FL 33611 | to} a0 15.0 2500 son : $1,004.45] 3379.36 MADDOX, JEFFREY W 25-49-3601 GENERAL [o $25.58 10459 ROSE RO 0 LABOR saat | 374.50 stizar | se4e-r3 TALLAHASSEE, Fl. 32511 s| | as|insel ssn 22.24 1108 3764.50 ° 5 a ° ° 8 ° 8 allon coletonconilned in 29 GFA. 6§ 2.3, 8S) The Capoland Aah erfarming work on Federally financad or aeslsted eansivution contracts respond tothe Inf “nish woskty a slatement with respect tothe wages nald each employee during Ihe pracecing week.” U.S. apariment of Lebar {O01} regulators at by asigned "Stalameny of Compfance" indicating thatthe nayrals aca carzect and complele and that each laborer review the {a determine thet hava recelved legally raqured wages and fringe benef, ‘While complation of Ferm WH-247 is optianal, iis mandatory far covered contactors and subsontractors {40 U.8.6, § 9145) contractors and subcontractors performing work on Federally franced or easlsld construction conlsets Te 29.G.F.R.§ 5.52) 2}0) requle contractors to subril Weekly @ copy af al payrlle to tha Federal agency A for or raneing the projec, ‘or machanfe has been pei not legs than the proper Davis-Bacon pravaling wage rate for he work performed, DOL and fedecal agencios reeslving this Pubic Burden Statomrant aoe rena tect fvmg0 of 86 minsas to comploo ts election, lung Une forreviawingfstuctons, searching esng data sours, gheng ad marsnng the dat needa, and carpeting and ovewing the tection of neato i you have echinaton