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

Regulations, Part 3 (29 GFR Sublite A), asued ty the Secretary of Labor under the Gopelend Act, as amended ' (48 Stat, 948, 63 Stal. 108, 72 Stat, 967; 78 Stal. 367; 40 U.S.C. 3148), and described below: FIGA, Withholding Tax, Medicare, Child Support INO WORK NAME AND TITLE SIGNATURE. (2) That any payrolls otherwise under this conlract required to be submited for the above ack period are cone and complete; that tha wage rates for laborers or mechanics conlained therein are not Mary Ann Scurlock M Anns less than the applicable wage rates contatned in any wage determination Incorporated info the contract; THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE that the claasificalions set forth therein for each laborer or mechanic conform with the work he performed, STATEMENTS MAY SUBJECT THE CONTRACTOR OR (3) That any apprentices employed in the above period ara duly registered Ina bona fide. SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE) ‘apprenticeship program registered with 4 State apprentloeship agency recognized by tha Bureau of SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Apprenticeship and Training, United States Department of Labor, orf no such recognized agency exists Ina State, are registered with the Bureau of Appreniiceship and Training, United States Department of Labor. (4) Thats (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS ae addition to tha basic hourly wage rates pald to each laborer or mechanie listed In the above referenced payroll, peyments of frige banaitaas sted In the contract hava been or wil be made to appropriate programs for the benefit of such employees, except as noted In Section 4(o) below. (6) WHERE FRINGE BENEFITS ARE PAID IN CASH [x Teach taborer or mechanic listed in he above referenced payroft has been pald, as indicated on the payrol, an amount not less than the sum of the applicable baste hourly wage rate plus the smount of the required fnge benefits as Nsted inthe Contract, excepl as noted in Saction 4(c) below. re0.01059 FY, wnesar constuction out Peaject and Location TW FL Regional Aiport Wage and Hour Record: Contractor's Hama I | diate eng Signy Fe ‘Guster & Guatler, Ine, Payroll Number (Ce ForWaek ending ‘Decembor 4 2012] Contract # FINE ty ) @ @ ductions (8) (to) crete 4) “Dayan Date Ti Dnae] sain Pog) Deus Te] salon and 4 Digit Idontitor in] Mon | Tues J Hours | Medicare ‘tal from otal Patd for | Fringe Benoit (8 digit 35 and fall aderane gf See] wen us] weal ey To tatding Baduction | Deductions / "ng" [PMN Bet required on contracts Let | (2) a i tax Sheet tattacnec) pélorto 1/9/08) Examplions / [Work Clasalt.| & (attached) aco 8 Gander] _teatton 18 | z6| sas 7 swvael rea) ao} sat Fis Taylor im 80 lo 9.00 | waa! wvaL.uey oasnans | wyuvner| rowan (o| {| PT so | sun | ss Ryan Gray | lo 00 | wane! avanue) XXX-XR-0027 cel Foraman_|8 | | | | 0.00 Salary $0.06) - ciiton Goidens I lo 00 |eateenel avaLuE Lexxsxxr42e wna Foreman _|6 | 9.00 _| Satary goog [chris Taylor | 30 lo 2100 | 9.00 Lat RXX-KK7268, White/Male Striping _|s_ 14,00 0.00) $ a tarsi issn $9.) 3 o 15.00 | 0.00 ‘enerai xex.xxseer ateskttse | Laborer |e oo_| 10.00 gooo|$ lwtiver @ninger ma | 8! gpg 2 o.00 | 2025 | oo Machine XXX-XX-0640, White/Mala | Nozzteman |& 0.00 13.50 $0,00} § = Beoty Davie 1-1 ondSgel | LT cae | ass |e | | Machine | | [XXXXK4114 Operator. (S 9.00. 14.28 $0.00] $ = Moseph gen, Jr. i | i $4) ay lo ooo | 16.00 | 990 ‘General JAXX-XX-9816 WhiteMate Laborer 0.00 10.00 $0.00) $ a Fauetn whtingion | 89! yy lo ooo | 1600 | 900 | | iGeneral | JRXX-KX-7044 wWinite/Male Laborer_|s. 0,90 10,00 $0.00] $ a ay Ter | al | 89! yorcommen® goo | 1725 | 090 | WGonerat hexxxxe298 woitenae| Laborer_[s ooo _| 11.50 ee isvon Leelnerwood | 2] qevcommon(® 0.00 | 15.00 | 9.00 | ‘iGonorab [XXX-XX-8697. WhiteiMals_ Laborer {S 0.00 10.00 $0.00] $ - Date 4213 I Allison M Clark Secretary (Name of Signatory Party) Tiley do hereby state: (1) That | pay or supervise the payment of the persans employed by INTEGRATED SYSTEMS OF FLORIDA, INC. on the (Cantractor oF Subcontractor) NWEFL REGIONAL AIRPORT PKNG LOT REN ; that during the payrolf perlod commencing on the ‘(Bullding or Work) 2 yor 12,2042 andendingthe__8__ day of alt persons employed on sald project hava bean paid the full weekly wagas aamed, that no rebates have been or will be made elther directly of Indirectly to or on bahalf of sald INTEGRATED SYSTEMS OF FLORIDA, INC. from the full (Contractor or Subcontractor) a aoa | weekly wages eared by any pereon and that na deductions have been made elther directly or Indirectly {0} WHERE FRINGE BENEFITS ARE PAID IN CASH [MZ] — Each laborer or mechanic listed In the above referanced payroll has been pald, as Indicated on the payrolt, an amount not lass than the sum of the applicable basic hourly wage rate plus the amount of the required fringa benefits as listed In the contrast, excapt as noled in section 4{c) balow. (0) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION from the full wages eamed by any person, other than permissibls deductions as defined In Re ns, Pai 2 (29 C.F.R. Subiille A), issued by the Seorelery of Labor under the Copeland Act, as amendad (48 Stal, 948, 63 Start. 108, 72 Slat, 867; 76 Stal. 367; 40 U.S.C. § 3145), and described below: Federal Withholding, FICA, and Insurance {2} That any payrolls otherwise under this contract required to be submitted for the abave perlad are corract and comptete; that the wage rales for laborers or mechanics cantalned therafn are not lass than the appiicable wage rates coniainad in any wage determination Incorporated Into the contract; that the classifications set farth therein for each laborar or mechanic conform with the work he performed. (3) That eny apprentices employed In tha above perlad are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency racognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or If na such recognized agency exists In a Slate, are registered with the Bureau of Apprenticeship and Training, United Stales Department of Labor. (4) That: (@) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: DD adaitton to the basic hourly wage rates pald to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been ar will ba made to appropriate programs for the benefit of such employees, except as noled! in section 4{c} below. REMARKS: val WAME AND THTLE SIGNATURE, 77.7 7] ALLISON M CLARK WEVA SECRETARY Zi a ——> THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO GIVil OA CRIMINAL, PROSECUTION. SEE SECTION 1001 OF TIYLE 18 AND SECTION 234 OF TITLE 1 OF THE UNITED STATES CODE, _ U.S. Department of Labor PAYROLL SHG Wage and Hour Diviston (For Contractor's Optionat Use; See Instructions at www.ctlol.goviwhd/farmefwh347instr.htm) US. Wage and Hour Divislon Rev. Dec, 2008 OMB No. 1215-0149 Expires: 12/34/2011 PROJECT OR CONTRACT NO, o774 Persons are nat required te respond to the cottection of information uniess it displays a currently valid OMB contro! number, ADDRESS 189 SCARLET BLVD, OLOSMAR, FL 34677 NAME OF CONTRACTOR [“] ~~ OR SUBGONTRAGTOR [7] INTEGRATED SYSTEMS OF FLORIDA, iNC, PAYROLLNO, POR WEEK ENDING 33 4208/2012 PROJECT AND LOCATION NWFL REGIONAL AIRPORT PKNG LOT RENO a @ a (4) DAY AND DATE, 6) (8) ral ® @ DEDUCTIONS s[m[r[w]t]/F[s ner cross WaT wages wore 2[3Ta[s [el 7 Ts |rom| ame | Sees wotatNe ben tora, | "ats CLASBIFIGATION HOURS WORKED EnGHDAY —HoURa array | agneo_| _eica_| “tye oTaen Josousrions| rox weex Orns, (0, LAST FOUR DIGITS OF SOOIAL SECURITY NUMBER) OF WORKER, NAME AND WDIVIOUAL DENTEVING NuMBER |, g NO LABOR THIS PERIOD ° a THO Geog Stae) cor eit 387 apllona la manalory fr coverad conracioe and sobcolecirapotxning wotk on Fudarly aod or sedated conanioles ontraci to raspond to tho information colecon contained in 20 C.F.R. 6 85, 5a), The Copeland Aal Secta gr ganeontaciere and sucontaciom partoring wack on Faderalyfoancad or aoulsted sonsicon contact chard noeties se respec! (othe wages peld each employes during tha praceding woak,* (LS, Daperiment of Labor (00L} renulstone at api eh) ronure contracors to eubmi weekly & copy ofl payols otha Fedral agency conPscting fr of maneng Ihe prolect, by a signed “Statement of Gomplance” insleating that the payeols are catract and camplsie and that each labocer or mechanic has been pal not ase than tha proper Davis-Bacon prevaling wage ral forthe work performed, DOL and fever! review the tadalermine that. hava received logslly raqured wages and fps berate, Pubiie Burden Statement Hie cotta ha sl ake a evoroge of 5 mioues la vamptsta hs cotocton, including Ue fe rvawlng insane searching sisting data eourees, gathering ané mainaiing tho data needed, and cmmotng snd reviewing the collcton of Infomation tyou have tashingen, BG azn se osmatee oF any ster aspect of Wis cafes, Ieuan suggestions for rading thls burden end Them cine Aces Wage snd Hour Divison, U.8, Department of Laber, Rootn $3602, 200 Consitution Avenue, NW, Washingian, D.C. 20210, pate___ 12/17/2012 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Sarah Harper Payroll Clerk i id [2] ~ Exch laborer or mechantc listed In the above referanced payroll has been paid, o (Name of Signatory Party) Citley as indicated on the payroll, an emount not fess than fhe sum of the applicable do heraby state basle hourly wage rate nlls ihe amount of the required fringa benefits as Fated : In the contract, except as noted in section 4(c) below. (1) That | pay or supervise the payment of the persons employed by (@) EXCEPTIONS Biti Smith Electric, Inc, onthe (Contractor or Subcontractor) EXCEPTION (CRAFT) EXPLANATION NWFRA Parking Rehab ; that during the payroll perlod commencing on the ‘Building of Wark) Bo cayot 122012 | anctending the 9 aay of. t2 aoiz all parsons employed on 8 ald project have been pald t he full weekly wages eamed, that no rebates have been or will be made silher diescily or indlrectiy to or on bahalf af said Bilt Smith Electria, nc. from the ful (Contractor or Subcontractor) weekly wages samed by any person and that no deduc tions have been made elther directly or Indirec tly from the full wages eamed by any parson, ather than permissible deductions ag defined In Regulations, Part 3 (28 C.F.R, Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 3 Start, 108, 72 Stat. 967; 76 Stat 367; 40 U.S.C, § 3146), and described below FICA, Federal Withholding, Medical Inaurance REMARKS: (2) That any payrolls otherwise under this contract requlrad to be submitted for the above parind are corract and complete; that the wage rates for laborers or mechanics contained thereln are not jees than the applicable wage rates contalned in any wage det ermination incorporated Int o t he ¢ ontract; t hat t he leseifications set forth tharaln for each laborsr or mechanic confarm with the work he perfarmed. (3) T hat any apprent ices em ployed int he abov 8 pstiod are duly registered in @ bona fide pprenticeshlp program regis tered w Ith a St ate apprant lneship agency recognized by the Bureau of Anprenticeshlp and Training, United States Department of Labor, or ifno such recognizad agency existe In a Siete, are regiaterad with the Bureau of Apprenticeship and Training, United States Dapariment of Labor. @ That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS NAME ANO TITLE Sarah Harper, Payrall Clerk OO in sation ta tie basic hourly wage sales paid to each faborer or mechanic listed ih the above referenced payroll, payments of fringe benefits as listed in the contract THE WALFUL FALSIFICATION FANYO FT HEAGO VEST ATEMENTSM AYSUBI ECTT HEG WN SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSEGUTION. SEE SECTION 1001 OF TITLE 18 AND