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

INS. SUPP. INS OTHER OEDUCTIONS WEEK ° 0.50 0.50 | $25,675 |$694.79 Leta TRAVIS io | ELECTRICIAN $49.71] $ 56.37} $36.00 | $8.97 3151.05 | $543.74 $ | 0.00] 10.00] 10.00} 10.00} 19.00] 0.00}0.c0} 40.00 | $17.050 3694.79 ANDERSON, PAUL gio | LABORER, o 0,00] 0.00] 0.00] 0.00 0.00 | $12.210 |s0.00 ; fea a8 5947 GENERAL $ - |s - 30.00 , , s | 0.00] 0.00] 0.00] 0.00} 0.00] 0.00] 0.00! 0,00 | $8,140 $0.00 © | 0,00} 0.50] 0.50] 0.0} 0.50 2.00 | $25.575 $733.15 ca ae S/2 | ELECTRICIAN $ 56,09] $ 72,55] $103.85 $ 171.78] $404.27 | $328.89 | 0.00] 10.00} 10.00] 10.00] 10.00} 0.00} 0.09 40.00 | $17.050 $733.18 ° 0.50 0.50 | $12.210 $331.74 i] \. lial S| cece, $25.38 | $ 23.58] $0.00 $43.96 | $282.75 | 0.00] 10.00 10.00} 40.09] 10.09] 0,00} 9.00} 40.00 $8,140 $331.71 ° 0.00 | $28.50 |$413.25 rca sia | ELECTRICIAN $58.14] $101.13] $0.00 $159.27 } $6¢0.73 S | 0.00] 0.00} 10.75] 11.00] 0.00] 0.00] 0.00) 21.75 | $19.C00 $780.00 LABORER: | 9 0.00 | $15.760 $228.38 aes DONALD si0| GENERAL $32.13 | $ 48.07] $0.00 $80.20 | $339.81 APPRENTICE | s | 0.CO} 0.00] 10.75) 11.c0} 0,00] 0.00] 0.00} 21.75 | $10.500 $420,01 \ . 0.00 | $15.000 /$200.co ads WEStey mio Ceneat $18.30} $ 4.04] $0.00 $19.24 | $180.65 3 | 0.00] 10.00] 10.00] 0.00} 0.00} 0.00] 0.00) 20.00 | $10.000 $200.00 ° 0.00 $0,000 |$0.00 3 - |3 - $0.00 $0.00 $0.00 8 | 0.00] 0.00] 0.00] 0.00} 0.00] 0.00] 0.c0} 0.00 $0.0C0 $0.00 While completion of Form WH-347 is optional, 'tis mandatory for covered contractors and sudcantractors parfarming work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F R. §§ 3.3. 5.5(a), Public Burden Statement the dala nesdad, and comelating and raviawing the collection af infor Wa astimate that is wil eka an average of §5 minules to comoiate ‘his collection, including tima for reviewing instructions, saarching axisting dala sources, gathering and (over) Date: 8110/2013 Human Resources Kristina Pacino ‘ (Name of Signatory Party) (Title) do hereby state; (1) Thal ! pay or supervise tha payment of the parsons employed by Sill Smith Electric, Inc / Southeast Personnel Leasing on tha (Contractor or Subcontractor) NWERA Ron Apron High Mast Lighting ; that during the payroll periad commencing on the (Building or Viork) 27 day of May , 2013 _, and ending the 2 day of June 1 2013 y all persons employad on said project have been pald the full weekly wagas earned, that no rebates hava been or will be mada either directly or indirectly to or on behalf of sald Bill Smith Electric, Inc / Southeast Personnel Leasing (Contractor of Subcontractor) weekly wages earned by any person and that no deductlons have baen made aither directly of Indirectly from the full Part 3 (29 C.F.R. Subtitle wages earned by any person, othar than p as defined in A), Issued by the Sacratary of Labor under the Copeland Act, as amanded (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 3s 3145), and describad balow from the full (0) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer of mechanic listed in the above referanced payroil has bean paid, as indicated on the payroll, an amount rot lass than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contracl, except as notad in section 4(c) below (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION see attached payroll REMARKS: (2) That any payrolls otherwise under this contract raquired to be submilted for the above period are corract and complete; that the wage rates for laborers or mechanics contained there/n ara not less ‘han the applicable wage rates ined In any wage Into the contract; that the classifications set forth therein for each laborar of mechanic conform with the work he performs. (3) That any apprentices employed in the above period are duly rag! din a bona fide ragistersd with a State apprenticeship agency recognized by the Bureau of Apprenticeship ‘and Training, fini’ States Department of Labor, or if no such recognized agency exists in a Stats, are registered with the Bureau of Appranticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE 3ENEFITS ARE PAID TO CI} in addition to the basic hourly wage rates pald to aach laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have baen or will ba made to aparopriate programs for the banefit of such employaas, except as nofsd in section 4(c) below. Kristina Pacino, Human Resources THE WILLFUL FALSIFICATION CF ANY OF THE ABOVE STATEMENTS: |UBJECT 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 COCE. U.S. Department of Labor PAYROLL (For Contractor's Optlonal Use; See Instruction at wew.dol.goviasa/whd/forms/wh347instr.htm) Persons are not raquired to respond to the coolectian of information unless it displays a currently valid OMB control number. His U.S. Wage nd Move Diviton Rev. Dec. 2008 Wage and Hour Division 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: 01/31/2016) PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACTOR NO. 19 | 6/9/2013 NWFRA Ron Apron High Mast Lighting SUFL2009-224 (1) (2) (3) (4) DAY AND DATE (5) (8) (0) (8) () Hf | mM] 7 [w]tm|F | 8 [su DEOUCTIONS & So. WitH NET WAGES NAME AND INDIVICUAL IDENTIFYING 533 WORK 5 os | 814 ais | ais | 677 | 6/8 | 6/0 TOTAL IGROSS AMOUNT! HOLDING | HEALTH TOTAL PAID FOR NUMBER OF WORKER 38h CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER OEDUCTIONS WEEK ° 0,00] 4.00 4.00 | $25,575 {$784.30 ee TRAVIS M0 | ELECTRICIAN $56.56 | $ 69.79] $36.00 | $8.97 $171.32 | $812.98 $ | 8.00} 8.00] 9.00} 11.00] 4.00] 0.00) 0.00} 40.00 | $17.050 $784.30 ANDERSON, PAUL tagorer: | ° 0.00] 0,00) 0.00] 0.00 “0.00 | $12.210 {$0.00 aay Si0| GENERAL 3 - |$ - | $0.00 $0.00 $0.00 s {0.c0| 0.00] 0.00/ 0.00] 0.00} 0.00] 0.00] 0.00 | $8.140 30.00 O | 0,00] 0,00} 0.00} 0,00] 0.00 0.00 $25,675 |$520.03 a THOMAS 4 8/2 | ELECTRICIAN 339.78] $ 40.58 | $103.85 $ 171.78| $355.99 | $164.04 $ | 8.00] 8.00] 0.00] 6.50] 8.00] 0.00) 0.00] 30.50 | $17.050 $520.03 . fo} 0,00} 3.00 3.00 $12,210 |$362.23 os seni si naaleety $27.71| $ 28.16] $0.00 $55.87 | $306.36 S | 8.C0] 8,00] 8,00} 11.00] 5,00] 0.00] 0,00) 40,00 $8,140 $362.23 io 0.00 } $28.5¢0 s0.00 LASHEN SCOTT so | ELECTRICIAN s - 13 + | $0.00 $0.90 $0.00 $ | 0,00] 0.60] 0.00} 0.00} 0.00] 0.00] 0.00} 0,00 $19.000 $0.0 LABORER: | 0 0.00 | $15.750 |s0.00 soya JR., DONALD sin | GENERAL 3 - ls - | $0.00 $0.00 $0.00 APPRENTICE | 3 | 0.00] 0.00] 0.00] 0.00} 0,00] 0.00}0.00] 0.00 $10,500 $0,00 RICHARDSON, WESLEY wo| LABORER: 0.00: | $15,000: |#0.00 $0.00 $0.00 $0.00 0891 | GENERAL $ - |$ - u *0 ; $ | 0.00] 0.00] 0.00} 0.00] 0.00] 0.00] 0.00] 0,00 $10.000 $0.00 o 0.00 | $0.000 |so.c0 $ - 13 + | $0.00 $0.00 30.00 $ | 0,00] 0.00} 0,00] 0,00] 0.00} 0.00} 0.00} 0.00 $0.000 $0.00 While complation of Form WH-347 is optional, itis mandatory for covered contractors and subcontractors perfarming work on Federally financed or assisted construction contracts to respond {a the information coxection contained in 29 C.F.R. §§ 3.3, §.5(a). Public Burden Statement sgarching existing data scurces, gathering and maintaining the data needed, and completing arid reviewing (he cofection of Infor Woe ostimate that is wil taka an average of 55 minutes to complete this ccitaction, including time for reviewing (over) Dai: 6/13/2013 i, Kristina Pacino P Human Resources (Name of Signatory Party) (Title) do hereby stata; (1) That ! pay or supervisa the payment of the persons employed by Bill Smith Electric, Inc / Southeast Personnel Leasing on the (Contractor or Subcontractor) NWERA Ron Apron High Mast Lighting ; that during the payroll period commencing on the (Building or Work) day of June , 2013 3 day of June 2013, and ending the 9 all persons employad on sald project have been paid the full weakly wages earned, thal no rabates have been or will be made either directly or indirectly to or on behall of sald Sill Smith Electric, Inc / Southeast Personnel Leasing from the full (Contractor of Subcontractor) weekly wages eamsd by any person and that no deductions have basen made sithar directly or Indiractly from the full wages aamed by any parson, other than permissible deductions as defined in Regulations, Part 3 (29 C.F.R. Subtilla A), Issued by the Secratary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 987; 73 Stat. 357; 40 U.S.C, ss 3145), and dascribad below see attached payroll (b) WHERE FRINGE BENEFITS ARE PAID IN CASH - Each laborar or mecharic listed in the above referenced payroll has Seen pald, as Indicated on tha payroll, an amount not less than the sum of the applicable basic hourly wage rate plua the amount of the required Iringa benefits as listed In the contract, except as noted in section 4(c) below (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS: (2) That any payrolls otherwise under thls contract required lo be submitted for the above pariad are correct and complete; (hat the wage rates for laborers or mechanics ccntained therein are not lass than the applicable wage rates contalnad in any wage determination incorporated Into the contract; that the classifications set forth therain for each laborer of machanic conform with the work he performs. (3) That any apprerticas employed in the above period ara duly in a bona fida program Uf dwith a State ap ip agency by the Bureau af Apprenticeship and Training, United States Department of Labor, of if no such recognized agency axists in a Stale, are registerad wilh the Bureau of Apprenticeship and Training, United States Oapartment of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO ~ In addition to the basic hourly wage rates paid to each laborer or machanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be mada to appropriate programs far the benefit of such employees, excapt as noted in section 4(c) below. Pacino, Human Resources THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR GRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE iestusauenimene PAYROLL U.S. Department of Labor (For Contractor's Optianal Use; See Instruction at werw.dol.gov/esafwhd/forms/wh347 Instr.htm) Wage and Hour Division Persons ara no! required to respond to the coolection of information unless it displays a currently valld OMB contra! number. US. Wa z 3. ie and Uour Diviion 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: 01/31/2016) PAYROLL NO. FOR WESK ENDING PROJECT AND LOCATION PROJECT OR CONTRACTOR NO. 20 6/16/2013 NWFRA Ron Apron High Mast Lighting SUFL2009-224 (4) (2) (3) ; (4) DAY AND DATE (5) @) 7 neve ons (9) ai Bim | 7 [w{th] F{s [su 5 = Wi NET WAGES NAME AND INDIVIDUAL IDENTIFYING sf, WORK 6 5/10) a1] 6/12) 6/13 and] 8/15 6116 TOTAL IGROSS AMOUNT HOLOING HEALTH TOTAL PAID FOR NUMBER OF WORKER 23 if) CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER DEOUCTIONS WEEK ° 0,00] 0.00 0.00 $25.575 |$409.20 ie TRAVIS M/0 | ELECTRICIAN 334.75| $ 29.46} $36.00} $8.97 $109.18 | $390.02 & | 0.00] 11.00} 11.00] 2.00} 0.00} 0.00} 0.00} 24,00 | $17.050 $499.20 ANDERSON, PAUL tagorer: |° 0,00] 0.00} 0.00} 0.00 0.00 | $12.210 |s0.00 5947 S0| GENERAL s - |s - | $0.00 $0.00 | $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