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

HERNANDEZ-CARAMILLO, ALFREU 40.00]Health Insu-(a) $9.00}none $0.00 LABORER: COMMON GENERAL 401k-(b) $0.00 $0.00 Holiday-(c) EE $0.07 “=||Vacation-(d) |= He : $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 HOWARD, NATHIAN l 40.00] Health Insu-(a) $9.00|none $0.00 IMON GENERAI 401k-(b) E $0.00 Haiecaeee ered Holiday-(c) : $0.07 \Vacation-(d)_ |: : : $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 MOORE JR, JAMES WILLIE | 00]Health Insu-(a) $10.00]/EE- NT/ YES/ 1500 A $2.88 PIPELAYER/CONCRETE FINISHER 401k-(b) : $0.00 $0.00 Holiday-(c) HERES $0.08 Vacation-(d) HEHEHE: : $0.20 Total Fringe: $3.16 Add'l paid $0.00 Total $3.16 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 [ STATEMENT OF COMPLIANCE PAYROLL NUMBER, PAYROLL PAYMENT DATE CONTRACT NUMBER, 45-FINAL 12 O0CT 2012 DATE: |, KATHY L. VANCE, PAYROLL CLERK do hereby state: (1) That I 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 30 day of SEPT 2012 and ending the 06 day of OCT 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 GULE 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 GA Yee. The willful falsification of any of the above statements may subject the contractor , 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 GULF COAST TRAFFIC ENGINEERS, INC Certified Payroll Report 10-09-12 Page 4 Reg=Regular, OT=Overtime, Prm=Premium For the Period Ending 10-06-2012 Job: SS-1030 BOB SIKES A/PORT TAXIWAY#61201 Employee Number: ACO JA Name: JASON A. ACOBA 09-30 10-01 10-02 10-03 10-04 10-05 10-06 Total Cash Hrly Gross Total FWH SWH Other Caucasian Male Sun Mon Tue Wed Tho Fri Sat Hours Rate Fringe Fringe This Job Gross FICA SUI/SDI Deducts Net s- 0 COMMON LABORER Reg -50 .50 10.00 5.00 583.75 73,00 477.76 5.00 32.99 Employee Number: FLE JO Name: JOSEPH R. FLEMING 09-30 10-01 10-02 10-03 10-04 10-05 10-06 Total Cash Hrly Gross Total EWH SWH Other Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours Rate Fringe Fringe This Job Gross FICA SUI/SDI Deducts Net S - 3 COMMON LABORER Reg -50 +50 11.55 5.78 496.66 21.04 164.13 284.29 5.78 27.20 Totals for BOB SIKES A/PORT TAXIWAY#61201 09-30-12 10-01-12 10-02-12 10-03-12 10-04-12 10-05-12 10-06-12 Total Gross Total Sunday Monday Tuesday Wednesdy Thursday Friday Saturday Hours This Job Gross Deductions Net 00 1.00 -00 +00 .00 .00 .00 1.00 10.78 1,080.41 FWH 94.04 762.05 FICA 60.19 SWH -00 Other 164.13 EIC 00 GULF COAST TRAFFIC ENGINEERS, INC Deduction Register Period Check Gross Federal State city Other End Date Number Pay Taxes Taxes Taxes Deductions Net Pay ACO JA JASON A. ACOBA 10-06-12 583.75 105.99 477.76 FLE JO JOSEPH R. FLEMING 10-06-12 496.66 48.24 164.13 284.29 Employee FLE JO Totls: 48.24* .00* "00* 164.13* ~——-284.29% Report Totals: 1,080.41* 154.23* “00 SCF 164.13* 762.05* Vv = Voided Check 10-15-2012 Page 1 Scnacce Deduction Detail ---~-- > Deduction Amount: 125 AFLAC 9.18 125 DENTAL 6.04 401k 24.83 CHILD SUPPORT 101.23 GUARDIAN LIFE 2.77 401k LOAN PMT 20.08 164.13* 164.13* 41Sa 4aTE: 03-OCT-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 26 day of SEPTEMBER 2012, and ending the 2 day of OCTOBER 2012, all persons employed on said project have been paid the full weekly wages carned, that no rebates have been or will be made either directly or indirectly to or on behalf of said INGRAM SIGNALIZATION, INC. from the full earned by any person and that weekly wages directly or indirectly than no deductions have been made either full other earned by any person, from the wages permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle under the A), issued by the Secretary of Labor amended (48 Stat. 948, 63 Stat. 108, 72 3145), Copeland Act, as Stat. 967; 76 and described 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 bona fide apprenticeship program registered with a State apprenticeship agency recognized by the registered in a 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 7 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 programs for the made to appropriate benefit of such employees, except as noted in Section 49(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 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 amount of the required fringe rate plus the benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS : AUDREY FARAGHER ADMINISTRATOR j (Signature) THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY (Name & Title) 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. sATE: 03-OCT-12 13:26:49 INGRAM SIGNALIZATION, INC. PAGE: 26 COMPANY: 1 (01) (This Substitutes For: WH 347 / U.S. Department of Labor Wage and Hour / Public Contracts Division) (P63879) PAYROLL NO: 0000 PROJ: 1135 CONTRACT #: 61201-1462 CUST: ANDERSON COLUMBIA CO. ,INC WEEK BEGIN: 9/26/2012 NAME: ACCI NO:61201 BOB SIKES AIR- ADD1: 4522 NORTH DAVIS HWY ADD1: P.O. BOX 1829 WEEK END: 10/02/2012 LOCN: BOB SIKES AIRPORT TAXIWAY A ADD2: PENSACOLA FL 32503 ADD2: LAKE CITY, FL 32056 JUICE IIIS OOOO SG ISIS ISI H GGG GEE ne EMPLOYEE 4 DIGIT = FIT FICA LOCAL GROSS NAME & ADDRESS ID WED THUR FRI SAT SUN MON ‘TUES TOTAL sIT cIT DEDUCT OTHER RATE 26 27 28 29 30 1 2 sul SDI REIMBURSE NET FEISS IIIT GHG GHG G IG GG Ee JEFFERY SCOTT ALLEN 5542 Sex: M Race: W 2-00 Class: ELECTRICIAN Craft: R 11.00 11.00 10.00 .00 -00 8.00 00 40.00 159.23 55.57 -00 1,041.25 ° .00 +00 .00 +00 -00 3.00 10.00 13.00 .00 -00 60.58 .00 REG: 17.500 OvT: 26.250 GROSS: 1041.25 -00 .00 -00 765.87 Fete ee eee eee eee eee EERE EEE DEDUCTION DETAILS 00H GSE Ir PRE TAX HEALTH 52.64 | PRE TAX DENTAL 4.94 | UNIFORMS 3.00 | MARC JACOB HUGHES 2293 Sex: M Race: W 2-00 Class: GENERAL LABOR Craft: R 00 .00 +00 .00 -00 7.00 .00 7.00 127.12 48.32 .00 875.00 ° .00 -00 .00 .00 -00 4,00 .00 4.00 +00 .00 215.47 +00 REG: 14.000 oOvT: 21.000 GROSS: 182.00 -00 .00 -00 484.09 Fedo ggobbot biti kti itt itittttite DEDUCTION DETATILS 10GB E PRE TAX DENTAL 19.80 | LIFE INSURANCE 1.36 | COURT 191.31 | UNIFORMS 3.00 | PATRICK M. FLEMING 2302 Sex: M Race: W 2-01 Class: GENERAL LABOR Craft: R .00 00 +00 .00 .00 7.00 .00 7.00 58.85 31.79 .00 562.50 ° +00 .00 .00 .00 00 4,00 .00 4.00 00 -00 +00 .00 REG: 9.000 OVT: 13.500 GROSS: 117.00 00 -00 +00 471.86 JOHN D. PAINTER, UR. 3688 Sex: M Race: W 1-04 Class: GENERAL LABOR Craft: R 11.00 11.00 -00 +00 -00 -00 10.00 32.00 -00 16.28 -00 288.00 ° .00 -00 .00 .00 .00 00 .00 .00 .00 +00 +00 .00 REG: 9.000 OvVT: 13.500 GROSS: 288.00 .00 -00 .00 271.72 BRAD EARL WILSON 0473 Sex: M Race: W1-01 Class: ELECTRICIAN Craft: R 00 -00 10.00 .00 -00 .00 .00 10.00 139..17 71.65 +00 1,287.00 ° 00 -00 -00 .00 .00 .00 +00 00 -00 .00 21.81 -00 REG: 18.000 oOvT: 27.000 GROSS: 180.00 00 .00 -00 1,054.37 FREER R HAAR ERE E AEA E EERE ERR EEEEEE EEE DEDUCTION DETAILS UGG GOGH G SIGHED bbe PRE TAX DENTAL 18.81 | UNIFORMS 3.00 | JOB TOTALS: FIT: 484.37 FICA: 223.61 SIT: .00 CIT: -00 SUI: .00 SDI: +00 DEDUCT: 297.86 GROSS/ALL: 4,053.75 NET: 3,047.91 REIMBURSE: .00 REG HOURS: 96.00 OVT HOURS: 21.00 LOCAL: -00 WORK DEV: -00 OTHER: .00 GROSS/JOB: 1,808.25 61%, DATE: 10-OCT-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 3 day of OCTOBER 2012, and ending the 9 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