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

hoafoig (2102/62/60 Bulpuayaeqy) weve SIEJOL ADIOOM svveny SInOH TYOduIV SAMIS GOT V AVMIXVL - LOeTS TPETUOT LYOduIV SAIS GO "V AVMIXVL- LOZL9 :qor ZL0Z/6Z/6 - CLOZIEZI6 Pollad ydwosues] [joskeg payizies STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE 10/04/12 (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION I, HELEN H PORTER PRESIDENT (Name of signatory party) (Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by PORTER CONSTRUCTION COMPANY, INC. on the 3-12-0014-022-2010 C11-1852-AP Bob Sikes Airport Taxiway A Rehab. (Contractor or Subcontractor) (Building or work) that during the payroll period commencing on the 27TH day of Sep-12 and ending the 3RD day of Oct-12 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 REMARKS: PORTER CONSTRUCTION COMPANY, INC. from the full weekly {Contractor oF Subcontractor) 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 40 U.S.C 31 45), and described below: FICA, FEDERAL WITHHOLDING, MEDICARE, GRP.INS. , CHILD SUPPORT NAME AND TITLE SIGNATURE (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 Lo Jin addition to the basic hourly wage rates paid to each laborer or mechani 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 fx Jeach 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: listed HELEN H PORTER, PRESIDENT |q { \ \ eat, THE WILLFUL 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 ostes | os‘or | o0°or oo'or | s ain ayOIN a NHOr py2ze $|9060L $ Sbels | Opel $| soers | OsBe $ wOLNIMLSIC S/QareaWvW ory oo'sOL SLSL 00°0 ° . . deg S28; | O0.0b ad ae = yOavT WH Zauad 1 ODVILNYS every S| tebe S$ vos $i 199 $ oVel $ qwaaNna9 zoey os'ze sozb 00°0 oO g/OaldavW ; . . ; selv9 Sze oo'oL 00'y 00°9 s uoavi Wi AWMad ¥ NOSYr zosis = $ezzer $ | 068s $|erer $|eze $| zb9z $| pz9z $ qwuanz9o 0zs6 os'z8 secL 000 oO c/iGaMav 6S LLP Svs oor oor s WH . . Sa 1VYOW H TaVN eeece slosez $ 909 $ vS Lh $ swasngo 1979 ooee Beeb 00°0 ° vidarvW vo Loy S78 00°Ob oo'y 00'9 s WH i ' ZaWODS G NINDOWWN 6e'9zb $|sove $ 699 $]o98 $] 9°61 $ a res BLoL oss BezL 000 oO 9/GalduvW e629 oc6 00°OL oor 00's s wea . . wuvTo d Orda avoss = $ |9Z7 ZL vos $| 296 $|esrZs | zo'8z $ OP ROd Lzsp oo'e6 seeL ooo fo} WATONIS eLels oe6 OoOL oor 009 s wg 5 . ATWANOW Y GTVNIDIY osesp $lerosz $ | grb $|ve1z $|sror $|zszs $| Geez $ woven oose oo'e6 SeEL 000 ° e/FONIS oo'sz8 OO'rL oo'oL 00 009 s WIM sress $|z806Z $ | sOsZL $|vo6 $|z9z- $| pS zs$ | pS9e $ wOSIANadNS among eee 00°;OrL 001 00°0 ° e/aaryvW yaom1o; | S¥0ROMPaG | 3904s UoRoNpap | soueInsu] xe on 8019 cunoy | 04 | 204 | Hot | 0816 | 6zi6 | 82/6 | 2216 z {coisie cy ope Satsnios vo pied sabemjon| ‘OL —- | PauseHe Woy eIOL] nog SuiplouyiMm Apjaem) area fed | poy = | uoneouisseio 40m wear ei pee anien Weigk ae ine (6) ss200) peter (3) (5) M}JLIW]S}S]fTaqL a (e) (@) uieN eaxoidura suonanpaq (a) ayea pue Kea (py) 3 a dvzsartioovozzzortoozre| = # NIS LLLO “qeyay y Aemxe) yodiry saxis qog uojes07 pue yalold #yeQUOD ZLOz ‘¢ 48q90}90 Buipug yee 104 [ sz | JequnN |]osAeq uoyjonysuo} [ Lvpze VOINO14 WNNVINVW ‘£26 XOS'0'd ‘GVOU GTSISSLUVH OL6y ssouppy ONI ‘ANWdWOD NOILONYLSNOD HALYOd ] WEN S10}921]U0D 69-010-002 LY-HM uuoy piodey JNOH pue abena Date 10/18/2012 I; JANICE JOHNS EEO OFFICER (Name of Signatory Party) (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: 61201 TAXIWAY A,BOB SIKES AIRPORT, ; (b) WHERE FRINGE BENEFITS ARE PAID IN CASH a - 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 (CTFTSSZAB atgslNel 022-2070 that during the payroll period commencing on the 30 day of _September , 2012 and ending the 6 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: 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 fecognized by the Bureau of Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in a State, are Tegistered 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. REMARKS: L NAME AND TITLE ATURE 7 JANICE JOHNS C EEO OFFICER Ma tle Dd hi ABOVE STATEMENTS MAY SUBJECT THE OR CRIMINAL PROSECUTION. SEE SECTION 31OF THE UNITED STATES CODE. 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OOO 000 = aBuuy yseg yWiNOSY YOLVaadO YaaVTaMaavyD WA xagyeoey or'se (ISS) Vols} 70'80z GHZ 006 —00'0 006 00:0 000 000 a00 000 SINILYSAO yOLVaadO YsavIguaavuD +160-00-000 00'rr7L 115/07°919 OWS! 00°0r 000 007+ 006 00°01 00°0} 00°0! 000 uvInosy YOLVYadO YAGVIaMaqvyed OGNV74O NONNVHS ‘oayvTIv9 keg suoyjonpaqg Ssolp|sjunowy = ayey 301 38S Hy NYL pam any uoW uns UOHeoISSEID YON sehojdwy JON 12}0) foeforg (Z10z/90/01 Buipuayaayy) seeex SIEJOL ADOIM sana SInOH} IYOdgIV SAMS God V AVMIXVI- F0eTS “PeETUOD LuOdulV SSMIS GO" ‘V AVMIXVL - L0ZL9 “qor ZLOZ/9IOL - CLOZI0EI6 Poliad ydiosuel) |jouxeg poyies Anderson Columbia Co., Inc Fringe rate 61201 - BOB SIKES TAXIWAY | Weekending 10/6/2012 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate GALLARDO, SHANNON ORLANDO | 40.00] Health Insu-(a) $12.00|none $0.00 RATOR =]401k-(b) HH: : $0.00 $0.00 : "2 Holiday-(c) BRRBE $0.10 e|Vacation-(d) fis: Seeeeereereeettes H $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 | 40.00|Health Insu-(a) $10.50|/EE- NT/ YES/ 1500 A $2.88 none BACKHOE LOADER COMBO 401k-(b) $45.49 $1.14 1% LOADER Holiday-(c) $0.09 2% Vacation-(d) fe : $0.21 3% Total Fringe: $4.31 4% Add'l paid $0.00 5% Total $4.31 Craft Wage Health match/401k Fringe Employee Hours Fringe type base match Rate