Okaloosa County BOCC — December 18, 2012 — Bob Sikes Airport Taxiway A - Change Order #5, Close-out docs, Final Payment form — reading text

FALSIFICATION OF ANY OF THE ABOVE STATEMENTS 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. 700-010-69 Construction 01/11 ss’€09 0s'6 00's 00's s Wim HLOOS 8 LY3gON vresp = $l] iv ozL $ 9eLL $/ 898 $] ezsz $|PHSe $ yoLnauisia 66r0 Os'Ly styl | 000 ° ORTIONIS 00's99 os'6 00'9 oo9 s waArua WM 7a MOIN G NHOF 90709 $|Peeo eres jese $|zoers | r9Zz $ yon wav | eaarniwa oor 002s SevL 000 ° 29°86 sze | 00'0F ooror s wea WH Zavad 7 OOVLLNYS sezse $lezte ¢ vos $lizs $ vSOL $ WwugNa9 zoey os'z8 sez | 000 ° ggarav So'vss sve | 00's 00's joo‘or s woe Win Auuad 4 NOSWr oozer = =6$}soztL $ | o6ss $|6rier $|ee2 $|se9oL $|eszz ¢$ wuana9 ozs6 szezb | sezt | 000 fe) aay ozsLe sz'8 | o0'0L o0‘or| s sea wt eHow wiavN szo0e = $/zeZb oS wy $ geet $ qWwuangso 18z9 oszg | eezt | 000 ° viaarayw sero | Sze | oo'OL oor s uouni aul ZaWoo a NINDOwWN peze = $}uzsz ges $|eez $| seo $ WwaaNa9 hoz ose8 8eZb 00°0 ° g/araavW ss'e09 oc'6 | O0'0L oo‘ s win 1008 8 Lu3G0u vresp $lipoze ¢ gel $/ 998 $] ezszs | pEse $ gnewos 66r0 006 sect | 00'0 ° OFFIONIS ; ; £0'br9 oe6 | Oost 00's }oo'oL| S |yoavi IwuaNa9 NS AWWANOW ¥ GIVNIDaa sel6e $]s09rz $ | er irL $|velZ $|rL6 $] 90'Zb $| OP9z $ PIOLWaadO ooae os'6eL S6EL 000 o | -ovulisod S/F TONIS ossez | oot | ost 00's |oo‘oL| s wim . . . ; . . voinarusia a¥O4di 4 ANNYG zesty $|egz9z $ | go'szL $|ro6 $] p90 $| 90Ze$ | LEE $ AMOSIANSANS zg2z oo0rz | oor | oo ° S/GaIaUVN @ 6/0L LOL | 9/01 | SIOL | vIOL | & (601611 03 sud 327 s}oeU0D UO preg soBbem 3ON 7 7 1eyoL Q . 7 298y / SUONdwaxy Jeynuepl W6ig y pur (e) soup oafoud (9) As mi/if[w]s|s]ala Z (e) tz) sunigy wateidalg suonanpeg (@) aye pur fea (y) 3 “ avzser-tiootozzerrioozie| #NId LuLo -ageuey y femxe1 nody sons aoa uoqe007 pue yalold # eNO ZLOz ‘Ob 4840399 uononjsuog 629-010-002 L 2vpze VOINOT4 VNNVIMVW ‘£26 XOS‘O'd ‘GVO GTSISSLUVH Oley 2PE-HM UuOF | ssaippy ONI ‘ANVdINOD NOLLONYLSNOD YALNOd UOQUNN |]OJheg WEN SJ0}92U0D p4s090y JNOH pue ahem Deduction Record: Contractor's Name Payroll Number: PORTER CONSTRUCTION COMPANY, INC | Address a] For Week Ending 4910 HARTSFIELD ROAD, P.O.BOX 923, MARIANNA FLORIDA 32447 | 700-010-69 FIN # | 3-12-0014-022-2010 C11-1852-AP| October 3, 2012 Project and Location Contract # —— Bob Sikes Airport Taxiway A Rehab. Construction 01/11 CHILD Employee Name SUPPORT Amount DANNY F LIPFORD $175.08 $175.08 REGINALD D MCNEALY $141.48 $141.48 ERIC D CLARK $0.00 MARROQUIN D GOMEZ $0.00 NAEL H MORALES $0.00 JASON K PERRY $58.90 $58.90 $0.00 SANTIAGO L PEREZ $0.00 JOHN D MICKEL $0.00 Deduction Record: Contractor's Name PORTER CONSTRUCTION COMPANY, INC Address | 4910 HARTSFIELD ROAD, P.0.BOX 923, MARIANNA FLORIDA 32447 | 700-010-69 Construction Payroll Number: [ 7 | For Week Ending October 10, 2012 Contract # [i O14 FIN # | 3-12-0014-022-2010 C11-1852-AP, Project and Location Bob Sikes Airport Taxiway A Rehab. Employee Name aiaey Pil ft DANNY F LIPFORD $175.08 $175.08 REGINALD D MCNEALY $141.48 $141.48 ROBERT B BOOTH $0.00 MARROQUIN D GOMEZ $0.00 NAEL H MORALES $0.00 JASON K PERRY $58.90 $58.90 SANTIAGO L PEREZ $0.00 JOHN D MICKEL $0.00 ROBERT B BOOTH $0.00 STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 44 05 0CT 2012 |, KATHY L. VANCE, PAYROLL CLERK do hereby state: (1) That | pay or supervise the payment of the persons employed by GULF COAST TRAFFIC ENGINEERS, INC. on the _BOB SIKES AIRPORT = TAXIWAY A REHAB. that during the payroll period commencing on the 23. day of_ SEPT 2012 and ending the 29 day of _SEPT 2012, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or in behalf of said GULF COAST TRAFFIC ENGINEERS, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR 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. 276c), and described below: FICA AND WITHHOLDING TAXES PAID MISCELLANEOUS DEDUCTIONS ARE A VOLUNTARY, NON-INTEREST DEDUCTION, WHICH INCLUDE: COURT ORDERED CHILD SUPPORT, 401K & 401K LOANS, HEALTH, DENTAL & LIFE INSURANCE, 125 CAFETERIA PLAN ON HEALTH & DENTAL, AND SAFETY EQUIPMENT. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the 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 if no such recognized agency exists in a State, are registered with 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 ___-In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above 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, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed in the above referenced payroll had been paid as indicated on the payroll, an amount 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, except as note in section 4(c) below, (c) EXCEPTIONS EXCEPTION (Craft) EXPLANATION REMARKS NAME AND TITLE SIGNATURE KATHY L. VANCE, PAYROLL CLERK subcontractor to civil or criminal prosecution. See Section The willful falsification of any of the above statements may subject the contractée 9? 1001 of Title 16 and Section 231 of Title 31 of the United States Code. DD Form 879 PREVIOUS EDITIONS ARE OBSOLETE 1 NOV 68 INC Certified Payroll Report 10-02-12 Reg=Regular, OT=Overtime, Prm=Premium For the Period Ending 09-29-2012 GULF COAST TRAFFIC ENGINE Job: SS-1030 BOB SIKES A/PORT TAXIWAY#61201 Employee Number: FLE JO Name: JOSEPH R. FLEMING 09-23 09-24 09-25 09-26 09-27 09-28 09-29 Total Cash Hrly Gross Total WH SWH Other Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours Rate Fringe Fringe This Job Gross FICA SUI/SDI Deducts Gd COMMON LABORER OTT 1,50 1,50 17.33 26,00 760.28 58.61 RATES 26,00 42,10 Employee Number: HAR JO Name: JOHN 'T. HARP 09-23 09-24 09-25 09-26 09-27 09-28 09-29 Total Cash Hrly Gross Total FWH SWH Other Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours Rate Fringe Fringe This Job Gross PICA SUI/SDI Deducts S ~ 0 STRIPING MACHINE of 2.50 1.90 21.75 32.63 1,145.51 210,19 272.00 32.63 63.56 Totals for BOB SIKES A/PORT TAXIWAY#61201 09-23-12 09-24-12 09-25-12 09-26-12 09-27-12 09-28-12 09-29-12 Total Gross Total Sunday Monday Tuesday Wednesdy Thursday Friday Saturday Hours This Job Gross Deductions 00 +00 +00 .00 00 .00 3.00 3.00 58.63 1,905.79 PMH 268.80 FICA 105.66 SWH -00 Other 449.31 EIC +00 Page 1 Net 482.26 Net 599.76 Net 1,082.02 GULF COAST TRAFFIC ENGINEERS, INC Period Check Gross End Date Number Pay FLE JO JOSEPH R, FLEMING 09-29-12 760.28 Employee FLE JO Totls: 760.28* HAR JO JOHN 7, HARP 09-29-22 1,145.51 Employee HAR JO Totls: ——«+1,145.51* Report Totals: |: 1,905.79* V = Voided Check Deduction Register City Federal State Other Taxes Taxes Taxes Deductions Net Pay 100.71 177,31 482.26 /100.71* ~.00* “00 = °-177.31* «482. 26 273.75 272.00 599.76 273.75 00% .00* «272.00 ~——=—«599. 76+ 374.46* .00# ~,00* 449.31* 1,082.02* 10-05-2012 Deduction Detail Deduction 125 AFLAC 125 DENTAL 401k ILD SUPPORT GUARDIAN LIFE 401k LOAN PMT 125 AFLAC 125 DENTAL 401k AFLAC INSURANCE GUARDIAN LIFE 401k LOAN PMT 9.18 6.04 38.01 101.23 277 20.08 177.31* Date 10/26/2012 EEO Officer Title) I, Janice Johns (Name of Signatory Party) do hereby state: (1) That | pay or supervise the payment of the persons employed by ANDERSON COLUMBIA CO., INC. (Contractor or Subcontractor) on the Job: 6120+ TAXIWAY A,BOB SIKES AIRPORT, ; (CTETSSZAR Rade s Wel 022-2010 that during the payroll period commencing on the 7 dayof _ October, 2012 , andending the 13 day of October 2012 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said ANDERSON COLUMBIA CO., INC. (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR 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. 3145), and described below: No Work Performed See attached payroll for a list of deductions (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the 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, of if no such recognized agency exists in a State, are registered with 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 - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above 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, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 0 - Each laborer or mechanic | been paid, as indicated on isted in the above referenced payroll has the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as Section 4(c) below. (c) EXCEPTIONS listed in the contract, except as noted in EXCEPTION (CRAFT) EXPLANATION REMARKS: 7 x NAME AND TITLE SIGNAJURE WA Janice Johns EEO Officer MALL 4 = THE WILLFUL FALSIFICATION OF ANY CONTRACTOR OR SUBCONTRACTOR TO 1001 OF TITLE 18 AND SECTION 231 OF TIT! OF THEZABOVE STATEME! MAY SUBJECT THE oe OR CRIMINAL PRY CUTION. SEE SECTION 1 ‘ATES 310F THE UNITED S CODE. Date 10/29/2012 iF JANICE JOHNS (Name of Signatory Party) EEO OFFICER (Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by ANDERSON COLUMBIA CO., INC. (Contractor or Subcontractor) on the Job: 6120+ TAXIWAY A,BOB SIKES AIRPORT, : (CTETBSZAR alate 022-2070 that during the payroll period commencing on the 14 dayof _ October 2012 , andendingthe ___ 20 day of October 2012 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said ANDERSON COLUMBIA CO., INC. (Contractor