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

bans ‘or machanie ti been pald no! [eas than the proper Davis-Bacon prevailing wage rata forthe wark performed. OOl. and federal Pubtie Burden Statement (We estimato thats wil lak an average of 85 minutes to complate this collection, Including tine for reviewing Insiucfons, saarching exlting data sources, gathering and matnisniny the data neoded, and completing and reviewing tha collcton of Information. if you have ‘any eammanis regareng theta vstimates or any ather aspect of this collection, including suggestions for reducing this burden, sand them tothe Admminiswator, Wage and Hour Divlton, U.S. Department of Labor, Room 83502, 200 Consttulon Avene, NAW. Weachinglon, D.C. 20210, STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE December 19, 2012 (c) EXCEPTIONS EXCEPTION (GRAFT) EXPLANATION 1 Mary Ann Scurlock (Name of signatory party) tie) do hereby state: (1) That | pay or supervise the payment of the persons employed by Guettlor & Guattler, Ino. fon the FINAC412-1990-AP ‘(Contractor ar Subcontractor) ‘(Building or wark) that during the payroll period commencing on the ath dayof December and ending the 4th dayof December all persons employed ‘on geld project have been pald the full weekly wages earned, that no rebates have been ar wil REMARKS: ‘ba made elthar diractly or Indirectly to oF on behalf of sald Guettier & Gustler, Ino. {Contractor or Subcontractor) ‘wages eamed by any person and that no deductions have been made elther dlrectiy or indirectly fram the fullwages earned by any person, olter than permissible deductions es defined In Regulations, Part 3 {29 CFR Subtitle A), Issued by the Sacratary of Labor under the Gopetand Act, as amended (48 Stal. 948, 63 Stat, 108, 72 Stal, 967; 78 Stat $87; 40 U.S.C. 3145), and described below from the full weekly IGA, Withholding Tax, Medicare, Child Support Court Ordered Deduction 700-010-689 Construction 021 ‘See payroll sheet for deductions, (2) That any payrolls otherwise under this contract required fo be eubmited for he above period are correct and complete; that the wage rates for labarars or machanles contained therein are not {oss than the applicable wage retes contained in any wage determination Incorporated Inta the contract; thatthe classifications set forth therein for each laborar or mechanle conform with the work he performed. {) That any apprentices employed inthe above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or ftne such recognized agency exists Ina Stata, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. ) Thet: (2) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS i adaitlon to the basle hourly wage rates pald to each laborer or mechanic Hsted Inthe above referenced payral, payments of finge benefts as iste Inthe contract have baen or vil ba made lo appropriate pragrams for the benefit of such employeas, except as notad In Section 4(¢} below. (6) WHERE FRINGE BENEFITS ARE PAID IN CASH [x Je ach tatorer or mechanic sted In the above referenced payrolt has baen paid, as Indleated on tae payrall,an amount not less than the sum ofthe appicabla basic hourly wage rate plus the amount of ie requlted fringe benefits as sted Ia tha contract, except as rtd in Sectton fc) below NAME AND TITLE SIGNATURE Mary Ann Scurlock MN aglhrmrlanlod 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 231 OF TITLE 31 OF THE UNITED STATES CODE, 700.010-68 wed? CGonslastion on Projact and Location NAVFL Regional Aipoit Wage and Hour Record: Contractor's Name [ ] drat Gaetan Siam oes ‘Gusitor & Guotler, in. Payroll Humber: [RTT] rorwookendng December 18, 207 i Contract 6 FINE 7 i) @ ty lons % (10) sone ne (Bay and Bate TE ole] oll [agg Dettiong Tat | non, and 4 Dig idantiter sn | Men [un Hours Groas? i=] Me Paid for Fringe Benaft {adgh 38 and tl adress j [Spin ee ee heat Waokly holding Deduction | Deductions | "Week ‘Shost required on contracte Lot | 2} ap Gross x shoot (attached) ‘prtor to 4/16/08) Exemptions ¢ |Work Claselt-] $ fattached) race 8 concer] ation |B ioe | wo| sant el a nel wr Ryan Gray Ma lo o.oo | eneeneal evanuer, XxKAAK-0827 wanitermats | Foreman {6 y a0 _| Salary | 1.18000 [¢ _ 49.30|$ 132.00 |$ 16.67 $496.97| $963.03 witoursininger ; St, pratt | x.00_| 20.26 | 40,60 Machine XXX-HX-0640 ‘Whitofifale | Nozzieman |S E| 3.00 13.50 640.00__| § 22.60 |§ 6500 |§$ 7.03 $85.54 $ 484.49. Edgar Donjuan wot 9 2.00 | 15.00 | 30.00 HispaniciMa} — /Genorat XXXAXXI 74 Ja Laborar |S. E 2.00 40,00 947.50 | 14.80/$ 19.00} $ 6.09 $38.63] $_ 308.87, Nieson teatnonvond 2d ao lo 00 | 8.20 } 2000 fonnerad [XXK-KK-8607 WhiterMato, Laborer_|3 a 3.00 40.00 531.26 | $ 2235 }$ 2a00)$ 774 $ 80.00 $143.02] $386.23 Deductions Record: 700-010-689 Construction Contractor's Name [ ‘Guettior & Gusttler, tine, J Address [524 ey 80, Chipley, FL 02428 ] Payroll Number For Week Ending| December 15, 2012, Contract#| | {Ciz-1930-AP_ Project and Location[__NW FL Regional Alport FIN# [C12-1930-AP) 02/1 ‘Type a Deduction description in each hox and then record the amount of that Deduction for each employee (or leave blank). Employee Name (last, first) Child Support Total Deductions Amount Leathenood, Jason Child Support $90.00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE December 22, 2012 (0) EXCEPTIONS EXCEPTION (GRAFT) EXPLANATION \ Mary Ann Scurlock (Name of signatory party) ile} do heraby state: (1) That | pay or supervise the payment of the parsons employed by Gueltler & Guetta, Inc. on the FIN#C12-1938-AP ‘(Contractor or Subcontractor) ‘(Bullaing oF work) that during the payroll perlad commencing an the 48th dayof —-_Decamber and ending the Bend dayot ‘December all persons employed ‘on sald profeat have been paid the full weekly wages oamed, thal no rebates have been or will bbs made elther directly ar indirectly to or on behalf of said REMARKS: Guettler & Guetta, nc. from the full weekly (Contractor or Subcontractor) ‘wages earned by any person and that no deductions have been made elther directly or Indirectly from the Tull wages samed by eny person, other than psrmissibla deductions as defined in Regulations, Part 3 (28 CFR Subtite 4), Issued by the Sacretary of Labor under the Copeland Aci, as amended (48 Siat, 948, 63 Stat, 108, 72 Stat, 967; 78 Stat. 357; 40 U.S.C, 3146), and described bslow: FICA, Withholding Tax, Medicare, Child Support INO WORK NAME AND TITLE. SIGNATURE (2) That any payroll otherwise under thle contract required to be eubmitted for the above period are correct and complete; that tha wage rates far tabarers or mechanles contalned therelh ara not lass than the applicable wage cates contalned In any wage determination incorporated Into the contract; that the claasiications set forth therain for each laborer or mechanic conform with the work he performed. (8) That any apprentioas employed in the above period are duly registered In a bona fide apprenticeship programm registered with a State spprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labar, orifno such recognized agency exists ‘na State, are regletered with the Bureau of Apprenticeship and Training, United Slates Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addition to the basic hourly wege rates pad fo each laborer or mechanic fisted In the above referenced payrol, payments of Kinga benefits as sled n the contract have been or willbe made fo appropriate programs for the benefit of such smbloyees, excapt as noted In Section 4{c) below. (0) WHERE FRINGE BENEFITS ARE PAID IN CASH on eon laborar of machanic listed In the above referenced payroll has been patd, as Indicated on the payrot, an amount not fess than the sur of the applicable basie hourly Wage rate plus the amount ofthe requled fringe benefits as listed In the contract, except as noted in Section 4(c) below: Mary Ann Scurlock M Linh tutect THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION, SEE; SECTION 1004 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE, 700-010-69 Construction 02/14 700-010-409 WHT Construction oat Wage and Hour Record: Gontractar’s Name [ ‘Gusiler & Guster, he. ] ‘Adress (ies, cy 328 ] Payrol Number: (CUE) rorweek ening [77 December2e, Baia 1 contract # cI Project and Location TATE Regional Argo FINE TH 1 Gl 7 ductions 19) ti) enlaj are (4) Day and Date | itn [ray tats} Project (8)_De natiages [Totton and 4 Digit Identiner ‘aun | mon| Tues| wedltnurs] Fd] sa) Hours Grows? [FICE With- | Madicara Total trom Tolar Pald for. {Fringe Senet (9 lglt 85 ant (ul sfdroas 12 Weekly heling Deduetton | Deductions | Max Sheet rayutrad on contracts Let | (zp |p ‘Gross tex Sheot (attached) priorto 118/05) } exemptions {Work CiassIt4 2 (attached) Reco a Ganda teation | Ff sae|ranr| wia| rao] tna] voer| we atta M,Yaylor 20 lo 0.00 XXX-XK-9908 White/Male, Foraman_|S 9,00 $0.00] $ ~ Ryan Gray yo lo 0.00_| eewaneal avatuer | [XXX-XX:0827 WhiteMals Foreman _|S 0.00 Salary $0.00) $ “ feutan Golden St lo o.na_[eewaueal avaLust enanx-7a22 woitemata| Foreman _[s 9.00 | salary go.o0|$ font Taylor 20 la ooo | 2.00 | 9.00 glet exnxe-7206 whiewata | steping bs 9.00 | 1400 Et Mars! Gibson ee le oo_| 1800 | 9.00 ‘General XXKK-9887 Laboror_[3 0.00 10.00 30,00] $ = hvtbur Eriningor ad. oprataping © 900 | 20.26 | 9.00 Machine [XXX-XX-0840 WhiteAfale {_ Nozzleman [5 0,00. 43.50 $0.00] $ + [Scotty Davie 8a opiariing 2 9.00_|_21.38 | 9,00 Machine xwxorxttt Whteriale | Operator |. aon | 14.28 goools PDosenh aon, ar std an lo o.oo | 1500 | 9.00 ‘Ganeeat XXX-XX-9B 16 White/Mal Laborer |S p00 10,00, $0.00] $ . [austin Wrntingtan 80! poicommonl® 0.00 | 4600 | 9.00 Iaanaral KXXXX-7644 WhiteMato Laborer |S 0.00 10.90, $0.00 $ “ ity Tok sat an lo o.oo | 1725 | 0.90 ‘General [XXXXX-0236 Wittermale: Laborer {5 0.00 14,60 $0.00] $ = Masori Leatherwood ae lo ooo | 1800 |, 9.00 ‘General [XXX-XX-B697_ White?Mate Laborer |S 0.00 19.00 $0.00] $ a 700-010-69 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Consieton WAGE AND HOUR RECORD Statement of Compliance DATE January 2, 2013 (c) EXCEPTIONS EXCEPTION (CRAFT} EXPLANATION I Mary Ann Scurlock (Name of sfanatory party} (Title) do hereby state: (1) Thal | pay or supervise the payment of the persons employed by FIN #012-1090-AP. Gusitter & Guetta, no. on the (Contractor or Subcontractor) (Bullding or work} that during the payroll period commencing onthe 2rd dayof December and ending the 2th deyof ‘December al persons employed on sale profect have been paid the full weekly wages eamed, that no rebales have been or will be made either directly or Indirectly fo or on bahaif of sald REMARKS: Gvatttar & Guetta, Inc. fram the fut weekly (Contractor or Subeontractor) ‘wages eamied by any person and that no deductions have bsen made elther directly or ndtrecty from the tullwages eamed by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), Issued by tha Secretary of Labor under the Copeland Act, as amended (4 Stat. 848, 83 Stat, 108, 72 Stat, B67; 78 Stat. 967; 40 U.S.C. 3145), and described below: FIGA, Withholding Tax, Medicare, Chi Support INO WORK NAME AND TITLE [SIGNATURE (2) That any payrolls otherwise under this contract required to be submitted for the above Pero are