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

V AVMIXVI - L0eTS "PeyUOD LYOduIV SAMIS BOE "V AVMIXVL - L0ZL9 ‘qor Zb07/22/6 = - = ZLOZ/9LIE Pola ydwosuedy |joukeg poyniey Anderson Columbia Co., Inc Vacation-(d) $0.24 Total Fringe: $0.34 Add'l paid $3.26 Total $3.60 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate HAVEARD, BRANDON JOHN I 40.00)Health Insu-(a)[___$10.50/EE- NT/ YES/ 1500 A $2.88 BACKHOE LOADER COMBO 401k-(b) $42.24 $1.06 LOAD Holiday-(c) $0.09 Vacation-(d) $0.21 Total Fring $4.23 Add'l paid $0.00 Total $4.23 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate HERNANDEZ, JOSE I 40.00}Health Insu-(a) $1 none $0.00 LABORER: COMMO! 401k-(b) : $0.00 $0.00 Holiday-(c) $0.08 Vacation-(d) $0.20 Total Fringe $0.28 Adq'l paid $0.00 Total $0.28 Fringe rate 61201 - BOB SIKES TAXIWAY ] Weekending 9/22/2012 | Craft Wage Health match/401k — Fringe Employee Hours Fringe type base match Rate BENZ, ERIC WILFORD | 40.00) Health Insu-(a) $10.00/EE- NT/ YES/ 1500 A $2.88 LOADER 01k-(b) E | $0.00 $0.00 Holiday-(c) $0.08 Vacation-(d) |: 3 $0.20 Total Fring $3.16 Adqd'l paid Total $3.16 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate COOK, JOHN ANTHONY I 40.00) Health Insu-(a) $23.88/ES- TOB/ YES/ 1500 A $2.85 none FOREMAN/GRADER/ 401k-(b) EURREEG $38.22 $0.96 1% Holiday-(c) $0.19 2% Vacation-(d) $0.46 3% Total Fringe: $4.46 4% Add'l paid E $0.00 5% Total $4.46 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate GALLARDO, SHANNON ORLANDO I 40.00]Health Insu-(a) $12.00|none $0.00 RADER/BLADE OPERATOR 01k-(b) $0. $0.00 Holiday-(c) $0.10 WD Footnotes: (a) Health insurance: Company paid per hour based on employee election and 40 hours/week. (b) 401k: Dollar amount paid direct by company divided by the hours worked (c) Holiday: Paid 2 holidays per year- amount based on 2,080 hours per year (d) Vacation: Paid 1 weeks per year. Amount based on 2,080 hours per year Anderson Columbia Co., Inc ‘acation-(d) Fringe rate 61201 - BOB SIKES TAXIWAY ] Weekending 9/22/2012 | Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate HERNANDEZ-CARAMILLO, ALFREQ 40.00}Health Insu-(a) $9.00|none $0.00 none RETE FINISHER 401k-(b) $0.00 $0.00 1% Holiday-(c) $0.07 2% #:|Vacation-(d) $0.18 3% ringe: $0.25 4% Add'l paid $0.00 5% Total $0.25 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate MOORE JR, JAMES WILLIE | 40.00]Health Insu-(a) $10.00/EE- NT/ YES/ 1500 A $2.88 PIPE LAYER }401k-(b) j $0.00 $0.00 Holiday-(c) $0.08 Vacation-(d) $0.20 Total Fringe: $3.16 Add'l paid $0.00 Total $3.16 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate HOWARD, NATHIAN I 40.00}Health Insu-(a) $9.00|none $0.00 CON’ : 01k-(b) $0.00 loliday-(c) $0.07 $0.18 Total Fringe: $0.25 Add'l paid $0.00 Total $0.25 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate WHITNEY, CHRISTOPHER JAMES | 40.00}Health Insu-(a) $9.00/EE- TOB/ YES/ 1500 A $2.63 LABORER: COMMON GENERAL 401k-(b) $0.00 $0.00 LOADER Holiday-(c) $0.07 :|Vacation-(d) $0.18 Total Fringe: $2.88 Adqd'l paid $0.00 Total $2.88 WD Footnotes: (a) Health insurance: Company paid per hour based on employee election and 40 hours/week. (6) 401k: Dollar amount paid direct by company divided by the hours worked (c) Holiday: Paid 2 holidays per year- amount based on 2,080 hours per year (d) Vacation: Paid 1 weeks Per year. Amount based on 2,080 hours per year STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 42 21 SEPT 2012 DATE: |, 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 09 day of SEPT 2012 and ending the_15 day of SEPT NO WORK PERFORMED 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 GE ss The willful falsification of any of the above statements may subject the santiector or subcontractor to civil or criminal prosecution. See Section 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 STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 43 28 SEPT 2012 DATE:_ |, 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 16 day of SEPT 2012 and ending the 22 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: NO WORK PERFORMED. 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 “gpl /, The willful falsification of any of the above statements may subject the sannloese or subcontractor to civil or criminal prosecution. See Section 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 + 14g DATE: 26-SEP-12 I, AUDREY FARAGHER , ADMINISTRATOR (Name of signatory party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by INGRAM SIGNALIZATION, INC. on the ACCI NO:61201 BOB SIKES AIR- that during the payroll period commencing on the 19 day of SEPTEMBER 2012, and ending the 25 day of SEPTEMBER 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 INGRAM SIGNALIZATION, INC. the full weekly wages earned by any person and that from 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 A), issued by the Secretary of Labor under the amended (48 Stat. 948, 63 Stat. 108, 72 3145), CFR Subtitle Copeland Act, as 967; 76 and described Stat. Stat. 357;40 U.S.C. below: (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 classification set forth therein for each laborer or mechanic conform with the work he performed. period or (3) That any apprentices employed in the above 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 x 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 49(c) below. PAID IN CASH (b) WHERE FRINGE BENEFITS ARE 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 applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS: AUDREY FARAGHER ADMINISTRATOR A. cabets Lilhdeh. (Name & Title) signature) THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE