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

D.anet ne irae oreny ole aapect ofthe colecton, hetuing suageatonsforredudng hs burden, sond Ui aT Adnnsar, Wage and Hout Dion U.S, Depasiment of Labor, Roem $4602, 209 Conan Avena Ra ‘Washington, 0.6, 20210 Date____ 12/10/2012 \ Sarah Harper Payroll Clerk (Name of Signatory Party) Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by Bill Smith Electric, Inc. onthe ‘(Contractor or Subcontractor) NWFRA Parking Rehab hat during the payrall perlad commencing on the (Bullding or Work) 28 ayat, 4 2012 and ending the 2 _ day of 12 2012 all pers ons employed on a ald project have been pald t he full weekly wages earned, that no rebates have been ar will be made elther directly oF indirectly fo or on hahalf of eld Ill Smith Electric, ine. ‘(Contractor or Subcontractor) peck wages samed by any pers on and t hat no deduc tlons have been m ade either directly of Indirac thy fom the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3,28 GER, Suotlo ), seusd by the Secretary of Labor under the Copeland Act, as amore (48 Stat. 04, 63 Start. 108, 72 Stat. 987; 76 Stat. 387; 40 U.S.C, § 3145), and described below: from the full FICA, Federal Withholding, Medical Insurance {2) That any payrolls otherwise under this contract required to be & ubmitted for the above pariod are correct and complete; that the wega rates for laborers or mechanics contained therein are not fess than the applicable wage rates contalned In any wage det arminalion incorporated int at he ¢ ontract; { hatt he classifications set forth therein for each laborer or mechanic conform with the work he pertarmad, (3) T hat any apprent Ices em ployed Int he above pertod are duly registered in a bona fide apprenticashfp program regis feted w ith a St ate apprent leeghip agency recognized by the Bureay of Apprenticeship and Tralning, United States Department of Labor, or if no such recognized agency axlate in a State, are registered with the Bureau of Apprenticeship and Training, United States Department af Labor. (4) That: (8) WHERE PRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS DF in adation the basic hourly wage rates pald to each laborer or mechanic listed in tha above referenced payroll, payments of fringe benefits as llated In the contract have been or willbe made to appropria te progra ms for the bene fit of such employees, except as notad In sectlon 4(c) helow, (b) WHERE FRINGE BENEFITS ARE PAID IN CASH [ZI — Each taborsr or mechanic listed In the above refarenced payroll has been pald, ag Indicated on the payroll, an amount not fess than the sur of the applicable foasic hourly wage rate plus the amount of the raquired fringe benefits as listed In the contract, except as nofed in section 4(c) below, (0) EXCEPTIONS EXCEPTION (GRAFT) EXPLANATION REMARKS; TRAME AND TITLE SIGNATURE Sarah Harper, Payroll Clerk THE WILLFUL_FALGIPIGATIONG FANKO FT HEABO VEST ATEMENTS M AY SUBJ EOTT HECO NTRACTORO R SUBCONTRACTOR TO GIVIL OR GRIMINAT PROSECUTION, SEE SECTION {004 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE, U.S. Department of Labor PAYROLL WH ‘Wage and Hour Division (For Contractor's Optional Use; Sae Instructions at www.dol.gov/whd/torma/wh347instr. htm) U.S. Wage ond Hour Division, Rav, Dac. 2008 Pareone are not required to respond to the cottection of information untess It displays a currentty valid OMB contro! number, NAME OF CONTRAGTOR fF") ‘OR SUBCONTRAGTOR {7] ‘ADDRESS: 408% Hidden Terrace Drive il ‘OMB No, 1235-0008 Bil Smith Electro, tno. Cantonment, FL 32533 Expires; 01/31/2015 PAYROLL NO, FOR WEEK ENDING PROJECT AND LOCATION PROJEGT OR CONTRACT NO, 35 satoniaot2 NWF Reglonal Alrport Rehab Public Parking 419994 Faofltles, Okaloosa County | C12-1999-AP w @ @ "A DAY AND DATE s ‘é 7 © ro) g A DEDUCTIONS wsenorovoueparme anc (gee gaa wll es Ts ve ¢ WITH: WAGES (a9, LAST FOUR DIGITS OF SOCIAL BECURITY HH WORK 52s] [oe] a9 [a0] [2 hora) are aroun noua | MEP. | CuO TOTAL {PAID NUMBER} OF WORKER 3 CLABSIFICATION HOURS WORKED EACHBAY™\wours| oF ray | ‘eapven | _rioa_| Tax d OTHER _jpEDUCTIONS| FoR WEEK Travis Tucker 4377 Electrician ° " [$187.55 1 $29.08 | $52.00 | $36.83 sii791 | $433.64 | 600 | sae 11.09 r05 455155 Henry Black 1416 Electrician Jo 102.30 4 $28.13 | $54.00 $46.57 $128.70 $415.60 ras | 60 6.00 $544.30 Tim Rutherford 5113, General ° ‘$110.00 2 Laborer $20.91 | $19.00 s39.91 | $330.09 | 640 | sso 100 Tod $370.00 . ° . lo ° 8 ° ° ‘While completion of Form WH47 fs optional, I ls mandatory for covered ontraciars snd eulbonniractore performing Wark on Facirally hanced ot agslatad construction cqnttac ta raspond tothe Information eolecian conialnad in 20 G.F.R, 8§ 9.3, &6(e) The Copeland Act anked of dasiatod construction contracts to Nurnish weekly a statement wh caspact fo tha wages pald each employee during the preceding week.” U.S, Deparment of Labor (DOL) ragulations at (40 U.8.6. § 3148) contractors and subconlraciors performing work an Faderally Mr 29 CER. § S.5{0)(3il) requite contactors to subral waskly @ copy otal payrolls to the Federal agency for ar financing the constzucian prolect, accompanied by a signed of G {Indicating thatthe payrols ere earact and complete and thet ech laborer ‘or mechania has been pald nat fase than the proper Davis-Bacon pravaling wage rate forthe werk performed. DOL and fedarat ‘agenoles racelving thie review the te determina that hava recelved legelyrequlred wages and nga banatls, Publle Burden Statement We estimate that Is wil ake an avarage of 86 rns ta compote this collection incung time for reviewing Insructlns, searching existing date sources, gathering end maintaining (he dala nasdad, and completing and ¢aviewing the collation of Infermation. I you have ny comments regarding these estimates or any alher aepecl cf thle calletion, Inluding euggastions (or eeducing this burden, send them to the Adminitator, Wage end Hour Division, U.S, Department af Labor, Reom 83602, 200 Constitution Avenue, NW, ‘Washington, D.C, 20210 Truart ~ 700-010-69 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Gonetveion WAGE AND HOUR RECORD Statement of Compliance: DATE December §, 2012 (EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION 4 Mary Ann Scurtook. (Name of signatory party) ite} do hereby state: (1) That | pay ar supervise the payment of the persons employed by fon the FiN #0412-1996-AP (Building of warky Novernber all persone employadt Guettier & Guster, Inc, (Contractor or Subcontractary that during the payroll perlod commencing onthe 26th dey of and ending the it dayof ‘December on sald project have been pad the full weekly wages aarned, that no rebates have baen ar will be made elther dlrectly oF indlractly to or on behalf of seld Guetties & Guatier, Ing. REMARKS: from the full weekly {Contractor or Subcontractor) wages eamned by any person and that no deductions hava bean made alther direatly or Indireclly from the ful wages earned by any person, other than permiselbie deductions as defined in Regulations, Part 3 (29 CFR Subtle A}, issued by tha Sacretary of Labor under the Copeland Act, es amended (48 Slat, 048, 63 Stat. 108, 72 Stat, 987; 76 Slat, 367; 40 U.S.C. 3148), and described below; FIGA, Withholding Tax, Madicare, Chitd Support INC WORK NAME AND TITLE [SIGNATURE. (2) That any payrolls otherwise under this contract required to be submitted for the above ‘undo Mary Ann Scurlock Mary enmest perlod are correct and completa; thet the wage rates for laborers or mechanics contained therein are not fess than the wage rates contained In any wage. ination incorporated Into tha contract; THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE that the classifications set forth (herein fer each laborer or mechanic conform with the work he performed. STATEMENTS MAY SUBJECT THE CONTRACTOR OR (8) That any apprantices employed in the above period are duly reglatered in a bone fie SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE apprenticastifp program registered with @ State apprenticeship agency recognized by the Bureau of SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF Apprenticeship and Talning, United States Department of Labor, or If no such recognized agenoy exists THE UNITED STATES CODE. Ima State, ara registered with the Bureau of Apprenticeship and Training, United States Department of Labor. @) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS [in adaition te the basic haurly wage rates pad to each laborer or mechanic listed In the above referenced payroll, payments of finge benafits as listed in the contract haye ben or will be made fo appropriate pragrama for the benefil of such employees, excapt as noted In Section 4{c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH a taborer or mechante listed In the abova referenced payroll has been ald, as indicated on the payrel, an amount not ass than the sum of the ‘applicable basic hourly wage rate plus the amount of the required fringe hanefiis as sted In the contract, except as noted in Section 4(o) below: YS wHaer Wage and Hour Record: ro0.01089 Constwuetion art [exer 90, cpg FL 32820 ] ‘> Nama, Cc ‘Guottier & Guetter, Inc. ] Addresa Payroll Numbor: (C3) Forweek enng — [7 bacember i. 2072 —"] Contract 4 — Project and Location TFL Regional Aiport FIN# (caesar a a To w 8 fons @ (ie) ngage one (4) Day and Date sfc, [raftac) wee | ____(@)_ Deductions —— sag —|Nettars | total tom sand 4 Digit Idontifior wa Hours Gross! oY Medica tal rom ota ald tor. |Ftnge Benettt (@ digi 88 and tall adress Sun Mon | Tues! tes rts aS Woatly holding Deduction | Baductions | "Wonk ‘Sheet requlrad on contract e Oo) ‘rose tax Shoat tetteenon) priorto 1/1900) | Exemptions / [Work Clecsit (attached) Reco 8 Gander] teatlon | F126] s026| war] soze| sveo| syo| 2A wie f. Taylor $0 lo o.0o_| avai ZYALUEL XXKXK-3S96 whiterMale | Foreman |& 9,90_| Salary $0.00] $ = Ryan Gray 9 lo 0.00 _| ane] ¥VALUE! Lexiaxx.0827 whiteMale| Foreman _|s 9.00 _| Salary $0.00] $ a faimen Golden $4 lo o.oo _ | entity! evALUEL xxx7422 WhiteMale | Foreman _|s a0 | Salary $0.001$ fonts Tayter 89 lo o.00_| 24,00 |. 9.00 a Lot xxx xx268 Whteivale | striping |s ego | 14.00 $0.00|$ Merial Gibson 0 ry lo ooo_| 15.00 | 9.00 ‘General Lxxk-xxses7 BiackiMalo| _ Laboror [a 0.00_| 40.00 $0.00|$ lwilbur Brininger 51, siping 00 | 20.26 | 9.00 Machine peexeroc8640 vihitetala | Nozaloman js ooo | 15,60 $0.00, $ [scotty Davis 34._.| opmsinning o.oo | 2138 | 9.90 Machina acest whiterMato| Operator |s. 09 | 14.26 $0.00|$ sesoph Bish, Jr sad a lo oa _| 16.00 | 9,90 igenaral xxx 18 wnitenate | Laborer_|s o.oo | 10.00 go.oa]$_ [Austin whietigton 20! a, lo coo} 1800 | 9.00 IGenoral ea exK.7544 watteMalo | tabaror_|s 9.09 _|_ 19.00 $0.00] § = Biiy The $9} ape lo ooo} 17.28 | 9.90 ‘General xxx. xx-8236 aborer_|3 o.oo | 14.50 $0.00,$ [Jsson Leatierwoca 82} rycomment? 0.00 | 15,00} 9.00 ‘eonerai pexx.xx97 whttenae| Laborer |e o._| 10.00 soos 700-010-689 Construction STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION ttt WAGE AND HOUR RECORD Statement of Compliance: DATE December 6, 2012 - (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION 4 ‘Mary Ann Scurlock (Nama of signatory party) Tiley do hereby stale: (1) Thal I pay or supervise the payment ofthe persons employed by Gusttlor & Guettler, Ine, on the FIN #012-1938-AP ‘{Conlracior or Subcontractor) (Buliding or work) that during the payroll period! commencing on the 26th day ot November and ending the ist day of “Dacember all persone emptoyed ‘on seld project have been paid the full weakly wages eared, that mo rebates have been or will be made elther directly or indirectly lo or on behalf of said REMARKS: Guoltter & Guster, Inc. trom the full weakly (Contractor or Subcontractor) wages eamet! by any person and that no deductions have been made either directly or Indirectly from the {ull wages eamed by any person, other than permissible deductions as defined in