Okaloosa County BOCC — August 24, 2013 — RON Apron Hi Mast LIghting -VPS_Certified Payroll — reading text

BILL SMITH ELECTRIC PO Box 1057 Gonzalez, FL 32560 Office (850) 968-6500 Fax (850) 937-8113 AVCON Inc. August 13, 2013 Attn: John Collins 320 Bayshore Drive Niceville, FL 32578 Subject: RON High Mast Lighting Gentlemen: All work shown on the certified payroll forms for the RON Apron High Mast Lighting project after June 10 was for scheduled training of airport and airline staff. This training was,scheduled at the earliest possible opportunity based on airline staff schedules. cerely, ake Smith © roject Manager Any wc le Sheen on ¢lk Corp fied Payro/! forms affe— Jure (0, 2013 ts got cacludud in ple Pinal wy Agel capbr Cpe Boplicabin M6). Go MNeg PP) iC Mengeer fugst /3, 20/2 (For Contractor's Optlonal Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) U,S. Wage and Hour Division Rev. Dec, 2008 U.S. Department of Labor Wage and Hour Divislon Parsons are not required to raspond to tha collection of information unlass it displays a currantly valld OMB contro! number. NAME OF CONTRACTOR [_] OR SUBCONTRACTOR [J] oe 4095 Hidden Terrace Drive OMB No.: 1235-0008 Bill Smith Electrio, Inc. | Cantonment, FL 32533 Expires: 01/31/2015 PAYROLL NO, i FOR WEEK ENCING | PROJECT AND LOCATION PROJECT OR GONTRACT NO. 9 03/31/2013 | NWFRA Ron Apron High Mast Lighting SUFL2009-224 (4) (2) (3) (4) DAY AND DATE (5) (8) (a) in {9) 2 B MITIWitH| Fi S| s DEDUCTIONS er NAME AND INDIVIDUAL JOENTIFYING NUMBER =| y 6 ; : WAGES (ag, LAST FOUR DIGITS OF Social secuRITY | 3 ; WoRK 5 25 | 26 | 27 | 28 | 29) 30 | 3! rorau] rare AMOUNT HOLEING MED: |) ,CHICy TOTAL PAID NUMBER) OF WORKER 2 CLASSIFICATION HOURS WORKED EACH DAY HOURS] __OF PAY EARNED | FICA TAX Ne bin OTHER _|DEOUCTIONS| FOR W' Travis Tucker 4377 Electrician ° $494.45 0 $44.18 | $30.00 | $36.83 $111.01 $503.44 8] 1.09] 5.00 | 3.00] 8.09 29.0(| 17.05 $614.45 Paul Anderson 5947 General ° $236.06 0 Laborer $23.49 | $23.00 346.49 | $260.61 S| 4.00 | 5.00 | 8.00 | 2.00 414 29.00 5307.10 0 s fe] 8 °o 8s oO a fo] 3 2 | 8 work on Faderslly financed or assisted construction contracts to respond to the Information colteation contalned In 29 C.F.R, §§ 3.3, 5.6(a). The Copaland Act |S. Oaparimant of Labor (DOL) ragulalions at While complation of Ferm WH-247 !s optional, ItIs mandatory for covered and (40 U.S.C. § 3146) and work on Fadarally financad of assistad construction contracis ‘o “fumish weekly a slatement with respect (0 the wages pald each employae during the praceding waek.” U, 20 C.F.R. § 5.5(a)(3)(H) requira contractors 0 aubm't weekly a copy of all payrolls to the Faderal agency contracting for or financing tha construction project, accompanied by a signed “Statemart cf Compitance® Indicating that the payrolls ara correct and complets and that sach laborer review the \ on to detsrmina that emp! hava recalved legally raquired wages end ‘tinge benefits, ‘or machanlc has basn pald not less than the proper Davis-Bacon pravailing waga rate for the work performed, OOL and federal contracting agancias receiving {his Pubic Burden Statement We aatimate that Is will ake an average of 56 minutes lo complete this ccllection, incluaing time for reviewing Instructions, searching axisting data sourcas, gathering and maintaining the data needed, and completing and raviewing the collaction of information, If you have any comments ragarding these estimates or any other aspect of this collaction, including suggeations ‘or raducing this burden, sand them ta the Administrator, Waga and Hour ONislon, U.S. Department of Labor, Room $3502, 200 Constitution Avenue, NW. Washington, 0.C, 20210 {ovar) Date ___ 04/08/2013 \ Sarah Harper Payroll Clerk (Name of Signatory Party) (Title) do haraby state: (1) That | pay or supervise the payment of the persons employed by Bill Smith Electric, Inc. onthe (Contractor or Subcontractor) NWFRA Ron Apron High Mast Lighting ; that during the payroll period commencing on the (Building or Work} 25 cay of 3 2013 and ending the 31 day of 3 2013 all persons employsd on sald project have been pald t he full weekly wages eamed, that no rebates have been or will be made either directly or indlractly to ar an behalf of sald Bill Smith Electric, Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and t hat no deduc tions have been m ade either directly or indirec tly from the full wages earned by any person, other than permissible deductlons as defined in Regulations, Part 3 (29 C.F.R, Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amendad (48 Stat. 948, 63 Start. 108, 72 Stat. 967; 76 Stat. 367; 40 U.S.C. § 3145), and described below: FICA, Federal Withholding, Medical Insurance (2) That any payrolls otherwise under this contract required t o be s ubmitted for the above pericd are correct and complete; that the wage rates for laborers or mechanics contained therein are not !ess than the applicable wage rates contained In any wage det ermination incorporated Int ot he c ontract; t hat t he classifications set forth thereln for each laborer or mechanic conform with the work he performed, (3) T hat any apprent Ices em ployedint he abov eperiod are duly registered In a bona fide apprenticeship program regls tered witha St ate apprenticeship agency recognized by the Bureau of Apprenticeship and Tralning, United States Department of Labor, or if no such recognized agency exists in a State, are ragistered wth 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 oO — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe bene fits as listed in the contract have been or wilde made to appropria te progra ms for the bene fit of such employees, except as noted in sectlon 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH WY ~ Each laborer or mechanic ilsted In the above referenced payroll has been pald, as indlcated on the payroll, an amaunt not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, excapt as noted in section 4(c) delow. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE Sarah Harper, Payroll Clerk THE WILLFUL FALSIFICATIONO FANYO FT HEABO V! SUBCONTRACTOR TO GIVIL OR CRIMINAL PROSECUTION. SEE SECTICN {C01 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CCDE. PAYROLL U.S. Department of Labor (For Contractor's Optlonal Use; See Instruction at www.dol.gov/esatwhd/torms/wh347Instr.htm) Wage and Hour Division Persons are not required to respond to the coolection of Information unlass it displays a currently valld OMB control number. US. Wage asd Hour Oicion Rev. Dec. 2008 NAME OF CONTRACTOR [_] OR SUBCONTRACTOR [_] [ADDRESS OMB No: 1235-0008 Bill Smith Electric, Inc / Southeast Personnel Leasing 1095 Hidden Terrace Drive, Cantonment, FL 32533 Explres: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACTOR NO. 10 4/7/2013 NWFRA Ron Apron High Mast Lighting SUFL2009-224 (1) (2) Q) : (4) DAY AND DATE 6) @ 7) peo ons (9) gg {mM |t]w[th] &[s [su gf i 42| 4a] 4a ais | 47 Witte NET WAGES NAME AND INDIVIDUAL IDENTIFYING [8 ea work 5 af as | al a7] sora GROSS AMOUNT| HOLDING | HEALTH tora. | PAIDFOR NUMBER OF WORKER: 23 CLASSIFICATION HOURS WORKED EACH DAY HOURS _| RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER | CEOUCTIONS WEEK ) 4.00 4.00 | $25.575 |sa29.95 Pete TAS M/0 | ELECTRICIAN $52.95] $ 62.72] $27.86 | $8.97 $152.50 | $576.47 8 | 9.00] 0.00] 0,00} 0.09] 4.00] 0.00} 0.00] 13.00 | $17.050 $728.97 ° 0.00 | $0.000 |s0.00 $ - $ $0.00 $0.00 $0.00 $ | 0,00] 0.00] 0,00] 0,00) 0.00] 0.00] 0,00 0.00 $0.000 $0.00 ° 0.00 | $0.000 $0.00 $ - |$ - $0.00 $0.00 $0.00 $ | 0,00} 0,00] 0,00/ 0.00} 0.00} 0.00] 0.c0} 0.00 $0.000 $0.00 g 0.00 | -$0.000 |$0.00 - $ - $ $0.00 $0,00 $0.00 8 | 0.00] 0.00] 0.00} 0.00] 0.00] 0.00] 0.00] 0.00 $0.000 $0.00 ° 0.00 | $0.000 |s0.co $ - $ - $9.00 $0.00 $0.00 $ | 0,00] 0.00] 0.00} 0.00] 0.00] 0.00) 0.00} 0.00 $0,000 $0.c0 Q 0.00 $0.000 | $0.00 $ - $ - $0,c0 $0.00 $0.00 $ | 0,00] 0.00) 0.00] 0.00) 0.00} 0,00] 0.00] 0.00 $0.000 $0.00 8 0.00 | $0.000 s0.co $ - S$ $0,00 $0.00 $0.00 $ | 0.00] 0.00] 0,60} 0.00] 0.00] 0.00) 0.00] 0,00 $0.000 $0.00 o 0.00 $0.000 |$0.00 $ - $ - $0.00 $0.00 $0.00 | S | 0.00] 0,00] 0.00] 0.00] 0.00] 0,00} 0.00} 0.00 $0.000 $0.00 work on Faderally financed or assisted construction contracts to raspond fo the information collection contained In 29 C.F.R. $§ 3.3, $.5(a). Public Burden Statement While completion of Form WH-347 | optional, it ls mandatory for covered and reviewing the coilection of infor We asiimale that is will taka an average of 55 minutes (9 complale this collesion, including me (or reviewing instructions, searching exisUng data sources, gathsring and mainta'ning the data needed, and (over) Date: 4115/2013 Human Rescurces Kristina Pacino i (Title) (Name of Signatory Party) do hereby state: (1) That | pay or supervise the payment of the persons employed by Bill Smith Electric, Inc / Southeast Persornel Leasing on the (Contractor or Subcontractor) NWERA Ron Apron High Mast Lighting ; that during the payroll period commencing an the (Building of Work) 4 day of April + 2.2013 _, and ending the 7 all persons employed on sald project have been pald the full weekly wages eamed, thal no rabates have been or wil! be made either diractly or Indirectly to or on behalf of sald Bill Smith Electric, Inc / Southeast Personnel Leasing from the full (Contractor of Subcontractor) weekly wages eamad by any person and that no deductions have been made elther directly or indirectly from the full wages earned by any person, other than as defined in Part 3 (29 C.F.R. Subtitle A), Issued by the Secratary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stal. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C, ss 3145), and described below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH '- Each laborer or mechanic listed in the above referenced payroll has been paid, as Indicated on the payroll, an amount not less than the sum of the appllcable basic hourly wage rate plus tha amount of the required fringe benefits as Ilsted In the contract, excapt as noted In sectlon 4(c) balow c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION day of April 1 2013 see attached payroll REMARKS; (2) That any payrolls otherwise under this contract required to be submitted for the above period are corract and complete; that the wage rales for laborers or mechanics contained therein are not less than the applicable wage rales In any wage Into the contract; that the classifications set forth therein for each laborer of mechanic conform with the work he performs, (3) That any apprentices employed In the above perlod are duly In a bona fide appr program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Tralning, United States Department of Labor, or If no such recognized agency exists in a State, ara registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO Cy In additicn lo the basic hourly wage rates pald to each laborer or mechanic listed In the above referenced payroll, payments of fringe oenefits as listed in the contract have been or will ba made to appropriate programs for the benefit of such employees, excapt as nated In section 4(c) below, Kristina Pacino, Human Resources THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR CR SUSCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. S86 SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL (For Contractor's Optional Use; See Instruction at www.dol.gov/esa/whdiforms/wh347Inste.htm) wy ‘on Wage and Hour Division