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

Parsons are not raquired fo respond to tha caolection of information unless it displays a currently vatid OMB contro! number. ig liseaet anes CSRS Rev. Dec. 2008 NAME OF CONTRACTOR = [_] OR SUBCONTRACTOR [_] ADDRESS OMB No: 1235-0008) 1095 Hidden Terrace Drive, Cantonment, FL 32533 Explres: 01/31/2018 PROJECT OR CONTRACTOR NO. Bill Smith Electric, Inc / Southeast Personnel Leasing OR WEEK ENDING PROJECT ANO LOCATION SUFL2009-224 PAYROLL NO. 14 5/5/2013 NWFRA Ron Apron High Mast Lighting (1) (2) (3) ; (4) DAY AND DATE (5) 8) (7) (8) (3) Be 3] m[ 7 [wth] Fs [su DEDUCTIONS e : WITH. NET WAGES. NAME AND INDIVIDUAL IDENTIFYING 383 WORK 6 4/28) 4/30) 5/1 | 8/2} 5/3 | 5/4 | S16 TOTAL GROSS AMOUNT HOLDING HEALTH TOTAL PAID FOR NUMBER OF ‘WORKER 958 CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER DEDUCTIONS WEEK t) "0.00 | $25,575 |s6s4.95 ies TRAMIS M/0 | ELECTRICIAN $ 48.05] $ 53.11] $27.86 | $8.97 $137.99 | $526,965 $ } 8.00] 8.00} 8.CO| 7.00] 8.00} 0.00) 0.00} 39.00 | $17.050 $664.95 . {oe 0.00 $12.210 $264.55 pale PAUL s/o eehenaE $20.24| $ 24.75| $0.00 $44.99 | $219.56 a S | 8.00] 3.50| 8.00] 0.00] 8.00] 0.00] 0.00] 32.50 | $8.140 $264.55 ° 0.00 | $25.575 |$528.55 PARKER; THOMAS $/2 | ELECTRICIAN $50.23] $ 61.05] $0.00 $ 275.63] $386.91 | $269.64 8649 $ | 0.00] 8.00] 8.00] 7.00] 3.00} 0.00] 0.00} 31.00 | $17.050 $656.55 ° 0.00 $0.000 {$9.00 $ - $ - $0.C0 $0.00 $0.00 $ | 0.00] 0,c0] 0,00] 0.00} 0.00} 0.00/ 0.00 0.00 | $0.000 $0.00, 9 0.00 | $0,000 s0.co $ - $ $0.00 $0.00 30,00 $ | 0.00} 0.00} 0.00] 0.00] 9.00] 0.00} 0,00} 0.00 $0.000 $0.00 o 0,00 30.000 $0.00 $ - |$ - $0.00 30.00 $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 |$0.00 $ - $ - $0.00 $0.00 $0.00 $ | 0,00] 0.00] 0.00! 0.00} 0.00] 0,00] 0,00} 0.00 $0,000 $0.00 fc) 0.00 $0.000 $0.00 $ - $$ - $0.00 $0.00 $0.00 s | 0.00] 9.00] 0.00] 0.00] 0.00] 0.00) 0.00) 0.00 $0.0C0 $0.00 While complation of Form WH-347 is optional, it is mandatory for covered and 9 Public Burden Statement tha data nasded, and completing and reviewing {na collection of infor 9 work on Fadarally financed or assisted construction contracts to respond to the intormation collection contained in 29 C.F.R. §§ 3.3, 5,5(a). searching existing data sources, gathering and We astimate that is will take an avarage of 55 minutes ta comple's this collection, including tima ‘or reviewing (over) Date: 5/10/2013 L Kristina Pacino , Human Resources (Name of Signatory Party) (Title) do hereby stale: (1) That | pay or supervise the payment of the persons employed by Bill Smith Electric, Inc / Southeast Personnel Leasing (Contractor or Subcontractor) NWERA Ron Apron High Mast Lighting , that during the payroll period commencing on the (Building of Wark) 29 day of April , 2013, and ending the 5 day of May 1 2013 all persons employed cn sald project have been paid tha full weekly wages earned, that no rebates have been cr corwill be made either directly or indirectly ta or on behalf of sald Bill Smith Electric, Inc / Southeast Personnal Leasing from the full (Contractor of Subcontractor) weekly wages eamed by any person and that no deductions have been made alther directly of Indirectly from the full wages eamed by any person, other than permisslble deductions as defined In Regulallons, Part 3 (29 C.F.R. Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stal. 948, 63 Stat. 108, 72 Stal. 957; 76 Stat. 357; 40 U.S.C. ss 3145), and described below ‘on the (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ~ Each laborer or machanic listed In the above referenced payroll has been pald, as indicated on the payroll, an amount nol less than the sum of the applicable basic nourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as notad In sectlon 4(c) beiow (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION s6e altached payroll REMARKS: (2) That any payrotls otherwise under this contract required to ba submitted for the above period are correct and complete; that the wage rates for laborars or mechanics contained therein are not less than the applicable wage rates In any wage Incorporated Into the contract; that the classificatlons sat forth therein for each laborer of mechanic conform with the work he performs, (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program with a State ap agency by the Bureau cf Apprenticeship and Tralning, United 9 States Department of Labor, or if no such recognized agency axists in a Stale, are registered with the Bureau of Apprenticeship and Training, United Slates Dapartment of !abar. (4) Thi (a) WHERE FRINGE BENEFITS ARE PAID TO in additicn to the basic hourly wage rates pald to aach laborer of mechanic sisted In the acove referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employees, sxcept as coled in section 4(c) below. Kristina Pacino, Human Resources THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS. ECT THE CONTRAGTORU SNTRAGTOR TO CIVIL OR CRIMINAL PROBECUT'ON. SEE SECTION 1001 OF TITLE 1YAND af STICN 231 OF TITLE 31 OF THE UNTT29 STATES CODE. PAYROLL U.S, Department of Labor A (For Contractor's Optlonal Uso; See Instruction at www.dol.gov/asa/whd/forms/wh347Instr.htm) Wage and Hour Division Persons are not required to respond fo the coolaction of information unless it displays a currently valid OMB contro! number. US. Wane and Hour Dee 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 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACTOR NO. 17 6/28/2013 NWFRA Ron Apron High Mast Lighting SUFL2009-224 TH re) 13 fa) DAY AND DATE @ Go) m Beau aN o 22 H M/T|W|Th| F} S [Su ‘ & q WITH: NET WAGES NAME AND INDIVIDUAL IDENTIFYING ass WORK 6 5120) 5/21) 5/22) 5/23} 5/24} 5/25) 5/28 TOTAL GROSS AMOUNT] HOLDING HEALTH TOTAL PAID FOR NUMBER OF WORKER g §8 CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER DEDUCTIONS WEEK ° 0.50 0.50 | $25.575 |s694.79 we a M/0 | ELECTRICIAN $50.33] $ 57.59| $27.86] 38.97 $144.75 | $550.04 $ | 8.00} 8.00) 8.00/ 8.00} 8.00] 0.00] 0.00} 40.00 | $17.050 $694.79 ANDERSON, PAUL LABORER: | ° 9.00 | $12.210 |80.00 5947 S01 GENERAL s - |$ - | $0.00 $0.90 $0.00 S | 0.00} 0.00] 0.00} 0.00] 0.00] 0,00/ 0.00} 0.00 $8.140 $0.00 © | 0.00] 0.00] 0,00} 0,00; 0.00 0.00 $25.575 |$605.28 EER THOMAS S/2 | ELECTRICIAN - $ 46.31] $ 53.36} $0.00 $ 275.63! $375.30 | $229.96 $ | 7.00] 8.50] 8.50] 3.c0] 8.50] 0.00/ 0.00] 35.50 | $17.050 $605.28 . $9 0.50 0.50 | $12,210 |$331.71 an MICHAEL si ponatg $25.38] $ 23.58] $0.00 $48.98 | $282.75 | 8.C0| 8.00] 8.C0| 8.00] 8.00] 0.00) 0.00] 40.00 | $8.140 $331.71 Q 0.00 | $26.500 |5285.00 a ia Seo §/0 | ELECTRICIAN $58.14 | $101.13 | $0.00 $159.27 | $600.73 s | 0.00} 0.00] 0.00] 8,50] 6.50} 0.00] 0.00] 15,00 | $19.0C0 $760,00 LABORER: ° 0.00 $15.750 |$157.50 oe JR., DONALD si0| GENERAL $ 32.13 | $ 48.07] $0.C0 $80.20 | $339.80 APPRENTICE | § | 0.C0} 0.00/ 0,00) 8,50] 6.50} 0.00] 0,00} 15,00 | $10,500 $420.00 LABORER: ; 0 0.00 | $21.735 |$115.92 fee CAMERON M/0 GENERAL $42.16] $ 41.56] $0.00 $83.72 $467.40 APPRENTICE | $ | 0.00} 0.00} 0.00] 0.00 8.00] 0.00/0.00] 8,00 | $14,490 $551.12 ° 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 Whita complation af Form WH-347 is optional, its mandatory for covered contractors and subcontractors performing work on Federally financed or assistad construction contracts (o respond to tha information collection contained in 29 C.F.R. §§ 3.3, 5.5(a). Public Burden Statement and reviewing ‘he collection of infor saarching existing dala sources, gathering and maintaining tha data needed, and (over) We estimate that Is wil taka an avarage of 55 minutas to complete this catlection, inc'uding time for raviawing i Date: 6/4/2013 Human Resourcas I Kristina Pacino (Title) (Nama of Signatory Party) do hereby slate. (1) That I pay or supervise the payment of the persons employed by Bill Smith Electric, Inc / Southeast Personnel Leasing (Contractor or Subcontractor) NWERA Ron Apron High Mast Lighting (Building or Work) on the ; that during the payroll perlod commencing on the 20 day of May , _2013_, and ending the 26 day of May » 2013 all persons employed on said project have been patd the full weekly wages earned, thal no rebates have been or will be made alther directly or Indirectly to or on behalf of sald Bili Smith Electric, Inc / Southeast Personnel Leasing from the full (Contractor of Subcontractor) weekly wages earned by any person and that no deductions have been made elther directly or indirectly from the full wages eamed by any parson, other than permissible deducticns as defined in Regulatlons, Part 3 (29 C.F.R. Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat, 948, 63 Stat. 108, 72 Stal. 967; 75 Stat. 357; 40 U.S.C. ss 3145), and described below see allached payroll (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or machanic listed In the above referenced payroll has bean paid, as indicated on the payroll, an amount nol less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, except as noled in section 4(c) below (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS: (2) That any payrolls otherwise under thls contract required to be submitted for the above period are correct and iny complete; that the wage rates for laborers of mechanics contained therein ara not less than the applicable wage rates in any wage into the contract; that the classifications set forth theraln for each laborer of mechanic canform with the work he performs. (3) That any apprentices employed In the above period are duly registered in a bona fide apprenticeship pragram registered with a Stale apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency oxists In a State, ars registered with the Sureau of Apprenticeship and Training, United Stales Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO CT} in addition to the basic hourly wage rates pald (o each laborer of mechanic listed In the above referenced payroll, payments of fringe benefits as ilsted 'n Ihe contract have been or will be mada to appropriate programs for the benefit of such employees, excapt as noted In section 4(c) below. 7 [ Kristina Pacino, Human sess} \ THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATE M CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF mya (NO SECTION 231 OF TITH PAYROLL U.S. Department of Labor Employment Standards Administration (For Contractor's Optional Use; Sea lon at www.dol. h347instr.Atm) Wage and Hour Division Persons are not requirad to respond to the coolection of information unless it displays a currently valid OMB control number. 148 Bbge and Mar Dicom 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 Expires: O1/att2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJEGT OR CONTRACTOR N 18 6/2/2013 NWERA Ron Apron High Mast Lighting SUFL2009-224 (1) (2) (3) . (4) DAY AND DATE (5) (@) 7) (8) . (2) by i M|T[w]th] FS [Su DESUSTONS —- 4 5 WATH- NET WAGES NAME AND INGIVIOUAL IDENTIFYING 0h WORK 6 527 5/28} 5/29] 5/90) 5/31} 6/1 | 6/2 TOTAL IGROSS AMOUNT] HOLOING | HEALTH TOTAL PAIO FOR NUMBER OF WORKER 23 CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX