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

$25.575 |$0.00 nt ella $/2 | ELECTRICIAN s - |$ - | $0.00 $ = | $0.09 | $0.0 $ | 0.00} 0.00] 0.00] 0.00] 0.00] 0,00] 0.00} 0.00 | $17.050 $0.00 BURNS, MICHAEL tagorer: |° 0,00] 0.00 0.00 | $12.210 $0.00 ; ; 3509 SM) GENERAL $ - {3 - | $0.00 30.00 | 30.00 = 8 | 0,00] 0.00] 0.00] 0,00} 0.00] 0.00} 0.c0} 0,00 $8.140 $0.00 ° 0.00 | $28.500 {s0.00 ree SCOTT so | ELECTRICIAN $ - |$ - $0.00 $0.c0 $0.00 S | 0.00] 0.00] 0.00} 0.00] 0.00] 0.00] 0.00 0.00 | $19.000 $0.00 LABORER: o 0.00 $15.750 [$0.00 en JR., DONALD si | GENERAL s - |s - | $000 $0.00 $0.00 APPRENTICE | § | 0.00] 0.00] 0.00} 0.00] 0.00] 0.00] 0.00) 0.00 | $10.500 $0.00 RICHARDSON, WESLEY Lagorer: | ° el ea ia 66 soco | sooo 0891 M0) GENERAL Sos [s 2 | j $ | 0.00] 0.00] 0,00] 0,00 0,00} 0.c0] 0.00} 0.00 $10.000 $0.00 ° 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 ng work on Federally financed or assisted construction contracts to raspond to the information collection containad in 29 C.F.R. §§ 3.3, 5.5{a). Public Burden Statement While compilation of Form WH-347's cptional, it 's mandatory for covered and pe and reviewing he collection of infor We astimate that is will lake an average of 55 minulas to compiato this collection, Including tima /or reviewing instructions, searching sxisting dala sourcas, gathering and maintaining ‘he da!a needed, and (over) Date: 6/21/2013 Human Resources (>) WHERE FRINGE S8ENEFITS ARE PAID IN CASH Each laborer or mechanic Iistad In the above referenced payroll has bsen pald, as Indicated on the payroll, an amount not fess than the sum of the applicable basic hourly wage rate plus ths amount of the required fringe benefits as Ilsted In the contract, axcept 1 Kristina Pacino ; (Name of Signatory Party) (Title) as noted In sectlon 4(c) below do hereby state: (1) That! pay or supervise the payment of the persons employed by (c) EXCEPTIONS Bill Smith Electric, Inc / Southeast Personne! Leasing on the EXPLANATION (Contractor or Subcontractor) EXCERTIONS (CRAFT) NWERA Ron Apron High Mast Lighting ; that during the payroll perlod commencing on the (Building or Work) 10 day of June , 2043 , and ending the 16 day of June » 2013 all persons employed on sald project have been pald the full weekly wages eared, that no rebates have been or will be made either directly or Indirectly to or on behalf of sald Bill Smith Electric, Inc / Southeast Personnel Leasing from the futt . (Contractor of Succontractor) weekly wages aamed by any person and thal no deductlons have been made either directly or Indirectly from the full wages eared by any person, other than permissible deductions as defined in Regulations, 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 Stat. 967; 76 Stat. 357; 40 U.S.C. ss 3445), and described below see attached payroll REMARKS: (2) That any payrolls otherwise under this contract required to be submitted for the above perlod are corract and complete; that the wage ratas for laborers or mechanics contained therein are not less than the applicable wage rates 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 ths above perlod are duly registered in a bona fide apprenticeship program registered with a Slate apprenticeship agency recognized by (he Bureau of Apprenticeship and Tra'ning, United States Department of Labor, or if na such recognized agency axists In a Slate, are regislered with the Bureau of Apprenticeship and Training, United States Cepartment of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO Ch In addition to (he basic hourly wage rales pald to each jaborer or mechanic listed in the above referenced payroll, payments cf fringe benefits as listed in the contract have been or will be made to appropriata programs for tha benefit of such employees, excapt as noted In section 4(c) below. THE WILLFUL FALSIFICATION OF ANY OF THE ASOVE STATEMEI IaNTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL FROSECUTION. SEE SECTION 1001 OF TITLE 18 ANO SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. PAYROLL U.S. Department of Labor jp! ini {For Contractor's Optional Usa; See Instruction at www.dol,gov/esatwhd/forms/wh347Instr.htm) Wage and Hour Division Persons ara nol required to respond to the coolection of Information unless !! displays a currently valid OMB control number. Gi Wo hewn 35 we 11d Hour Dinision Rev. Dec. 2008 NAME OF CONTRACTOR [_] OR SUBCONTRACTOR [_] (AODRESS 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. 21-FINAL 6/23/2013 NWERA Ron Apron High Mast Lighting SUFL2009-224 io) @ @ [___{4) DAY AND DATE 8) @) a) e0UCTIONS ° g bl mM [1 [wth] F | S$ [Su ° 335 eTenz|arel ar | 6/20 a WaTH- NET WAGES NAME AND INDIMOUAL IDENTIFYING [8 #3 WORK 8 18] 619] er20] 21] 622] 623} ory, ]GROss AMOUNT HOLOING | HEALTH tora} PAIDFOR NUMBER OF WORKER 2 53 CLASSIFICATION HOURS WORKED EACH DAY HOURS | RATE OF PAY EARNED FICA TAX INS. SUPP. INS OTHER ODEOUCTIONS WEEK 0.00 | 30.000 $0.00 el el WORKED THIS $ - $ $0.C0 $0.00 $0.00 S | 0.00] 0.00} 0,00] 0.06] 0.00] 0.00] 0.co} 0.00 $0.000 $0.00 5 0.00 0.000 $0.00 $ - $ - $0.00 $0.00 $0.00 § | 0,00] 0.C0} 0.00] 0.00} 0.06} 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 ° 0.00 $0,000 |$0.00 $ - $ - $0.00 $0.C0 $0.00 § | 0.00] 0,00 0.00} 0.00} 0.00] 0.c0/ 0.00] 0.00 $0.000 $0.00 ° 0.00 $0,000 $0.00 $ - $ $0.00 $0.00 $0.00 5 | 0.00} 0.00] 0.00] 0.00} 0.00] 0.00) 0.00} 0,00 $0.000 $0.00 od 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 ° 0.00 $0,000 $0.00 $ - $ - $0.00 $0.00 $0.00 $ | 0.00] 9.00] 0.00] 0.00} 0.00} 0.00] 0.00) 0,00 $0.000 $0.00 ° 0.00 $0.000 |$0.co $ - $C $0.00 $0.C0 $0.00 $ | 0.00} 0.00} 0.00] 0.00} 0.00] 0.00] 0.00] 0.00 $0.000 $0.00 work on =ederally financed or assisted construction contracts {9 respond {9 the Information collection contained in 28 C.F.R. §§ 3.3, 5.5(a) While completion of Form WH-347 is optional, it is mandatory for covered Public Burden Statement the data needed, and completing and reviewing the cotlaction of infor We astimata that is wil take an average of 55 minutes !o complete this collaction, mclucing time for reviewing instructions, searching existing data sourcas, gathering and (over) Date: 7/4/2013 , Kristina Pacino F Human Resources (Title) (Name of Signatory Party) do hereby slate: (1) That | pay or supervise tha payment of the persons employed by Bill Smith Electric, inc / Southeast Perscnnal Laasing or ) NWERA Ron Apron High Mast Lighting ; that during the payroll perlod commencing on the (Buikding or Work) on the 17 day of June , 2013 _, and ending the 23 day of June _2013 all persons employed on said project have been pald the full weekly wages gamed, that no rebates have been ‘or will be made alther directly or indirectly to or on behalf of sald Bill Smith Electric, Inc / Southeast Personnel Leasing from the full (Contractor of Subcontractor) waekly wages eamed by any person and thal no deductions have been made aither directly or indirectly from the full wages eamed by any parson, other than as defined In F Part 3 (29 C.F.R, Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stal. 948, 63 Stal. 108, 72 Slat, 967; 76 Stat. 357; 40 U.S.C. ss 3145), and described below see allached payroll REMARKS: (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ~ Each laborer or machanlc lIsted in the above raferenced payroll has agen pald, as Indicated on tha payroll, an amount not less than the sum of the appilcable basic hourly wage rate plus the amount of the required Iringe benefits as Isted In the contract, except as noted In section 4(c) below (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION a (2) That any payrolls otherwise under this contract required (a ba submitted for the above period ara correct and complete; thal the wage rates fcr laborers or machantcs contained therein ara not less than the applicable wage Into ‘he contract; that the classifications set forth therein rales in any wage for each laborsr of mechanic conform with the work he performs. (3) Thal any apprentices employed In the above period are duly registered In a bona fida appreniicaship program registered with a State apprenticeship agency recognized by the Bureau of Anpraniiceship and Tralning, Unitad States. Department of Labor, of if no such recognized agency exists In a Slate, ara registered with the Bureau of Apprenticeship and Tralning, United States Department of Labor, (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO ~ In addilicn to the basic hourly wage rales pald to each laborer or mechanic listed In the above referenced payrcll, payments of fringe benafits as IIsted In the contract have been of will be made lo appropriate programs for the benefit of such amployees, except as noled in section 4(c) below. NO HOURS WORKED THIS deshon foo x.) T pera ac Kristina Pacino, Human Resources THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS “AY SUBJECT THE CONTRACTOR OR SUBCCNTRACTCR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 ANO SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.