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

be made either directly or indirectly to or on behalf of said INGRAM SIGNALIZATION, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly the full other than earned by any person, from 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, 72 357;40 U.S.C. 3145), Copeland Act, as Stat. 967; 76 Stat. and described 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 incorporated into the contract; that the wage determination classification set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period or 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 hourly wage In addition to the basic vo WY rates the above referenced payroll, payments of fringe paid to each laborer or mechanic listed in benefits as listed in the contract have been or will be made to appropriate programs for the noted in benefit of such employees, except as Section 49(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed in the above indicated on the referenced payroll has been paid, as payroll, an amount not less than the sum of the applicable basic hourly wage required fringe rate plus the amount of the benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS ; AUDREY FARAGHER ADMINISTRATOR Fata. (Signature) Ao THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL SECTION 1001 OF TITLE 18 AND SECTION 231 OF (Name & Title) PROSECUTION, SEE TITLE 31 OF THE UNITED STATES CODE. DATE: 10-OCT-12 14:09:55 INGRAM SIGNALIZATION, INC. PAGE: 26 COMPANY: 1 (01) (This Substitutes For: WH 347 / U.S. Department of Labor Wage and Hour / Public Contracts Division) (P64218) PAYROLL NO: 0000 PROJ: 1135 CONTRACT #: 61201-1462 CUST: ANDERSON COLUMBIA CO.,INC WEEK BEGIN: 10/03/2012 NAME: ACCI NO:61201 BOB SIKES AIR- ADD1: 4522 NORTH DAVIS HWY ADD1: P.O. BOX 1829 WEEK END: 10/09/2012 LOCN: BOB SIKES AIRPORT TAXIWAY A ADD2: PENSACOLA FL 32503 ADD2: LAKE CITY, FL 32056 FEE ETI IIIS ITE III ITC GICICIEI GIGI III I IIIT CIITA III IRE EMPLOYEE 4 DIGIT 00 ween e n= = === =-----51 HOURS----------~----------- FIT FICA LOCAL GROSS NAME & ADDRESS ID WED THUR FRI SAT SUN MON TUES TOTAL SIT CIT DEDUCT OTHER RATE ) 4 5 6 7 8 9 sur SDI REIMBURSE NET JESSE EEE IESG ISIE II IEE IIIS SII OISIG TIES IEEE GIES SEIEISIITI ISI TTI TIT I JEFFERY SCOTT ALLEN 5542 Sex: M Race: W 2-00 Class: ELECTRICIAN Craft: R 11.00 11.00 11.00 .00 -00 7.00 .00 40.00 172.36 58.54 .00 1,093.75 ° -00 .00 .00 .00 .00 3.00 -00 3.00 -00 .00 60.58 .00 REG: 17.500 OVT: 26.250 GROSS: 778.75 +00 .00 .00 802.27 FEES pn bREE DEDUCTION DETALILS 00 G GGT T RE RIOR RR 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 11.00 .00 -00 +00 -00 11.00 127.12 48.32 .00 875.00 ° -00 .00 .00 .00 -00 -00 00 .00 .00 +00 215.47 +00 REG: 14.000 OvT: 21.000 GROSS: 154.00 00 .00 -00 484.09 GEO Opp npbbbibbiiiititittti® DEDUCTION DETAT LS UGG GGG GCG GCG I RR III Ie 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 11.00 .00 -00 -00 -00 11.00 58.85 31.79 +00 562.50 ° .00 -00 +00 .00 .00 -00 .00 .00 -00 .00 -00 .00 REG: 9.000 OVT: 13.500 GROSS: 99.00 +00 .00 +00 471.86 JOHN D. PAINTER, JR. 3688 Sex: M Race: W 1-04 Class: GENERAL LABOR Craft: R 11.00 11.00 11.00 -00 -00 7.00 00 40.00 -00 22.63 -00 400.50 ° .00 .00 .00 00 00 3.00 -00 3.00 -00 .00 -00 .00 REG: 9.000 OvT: 13.500 GROSS: 400.50 -00 -00 -00 377.87 JOB TOTALS: FIT: 358.33 FICA: 161.28 SIT: .00 CIT: .00 SUI: .00 SDI: -00 DEDUCT: 276.05 GROSS/ALL: 2,931.75 NET: 2,136.09 REIMBURSE: 00 REG HOURS: 102.00 OVT HOURS: 6.00 LOCAL: -00 WORK DEV: -00 OTHER: .00 GROSS/ JOB: 1,432.25 LL/ZO uononsjsuod, 69-010-002 “Hd009 SALVLS GALINN AHL JO l€ FILL 4O LEZ NOILOAS GNV 81 ATLL SO LOOL NOILOSS ‘NOILNDASONd TWNININS YO MAID OL YOLOVYLNOOENS YO YOLOVYLN HL LOANS AVA SLNAWALVLS CQ 3A08VSHL 40 AnvWo NOILVOISISTV4 INATAM AHL =F) ce oe ALNAGISSYd - AHdYNW ANNA :mojaq (9)h UNOS U! pajou se }deoxe ‘}9es]UO aU} U! pa}Si] Sse s]yoUaq Guy pesinbas ay) Jo JUNoWe ay) snjd ayes aBem Aynoy oIseq ejqeoijdde 84} JO WNs BU} UY} SSE] JOU JUNOWE Ue ‘|}oJAed aU} UO payedipul se ‘pred uaag sey |]0JAed peouesajes enoge ay} UI Pajsi| IUeYOeW JO Jes0ge| yes xX] HSV9O NI GiVd Suv SLISSN39 SONINS SYSHM () “mojeq (9)h UONOaS Ul pajoU se jdaoxe ‘seafojdwe yons JO JYaUEQ au) 10) SWesBoId ajeUdosdde 0} spew oq JO uaeq aney jDesU0D U4} Ul pajsi| Se syeauag eBuLy jo sjuawAed ‘|jouAed paouarajes avoge au} U! pajsi| Jueysaw Jo Jes0ge| YORE 0} pled seyes abem Alsnoy dIseq ay} O} UONIPpe uf SWVuY90ud YO SGNNA ‘SNV1d GaAONddV OL Civd SYV SLISSN3d SONI SYSAHM (e) weuL (v) ‘Joge7 Jo juaupedaq sajeig payun ‘Buiuresy pue diyseojuaiddy jo nesing ayy ym pelejsi6el ae ‘aye}S e Ul s\sixe Aouabe peziu6ooe1 yons ou 4! 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Hapusd g sey ing puuo | BuIpjo F BEDI (payoene) (pauene) iin ein a russel yom] / Suondwexg (60/6L/L 0} oud 2ous yeom 328US SSOID, 2 (e) (2) 307 $}9B4jUOD UO painbes i Z suononpag uononpeg Apia Fy ‘SSeuppe [Inj pue SS 3IBIP 6) ee iL cake hie TeI0L Woy 10L 1ss01 sunoH Ss s a ]il]m]a.]w iF Jeynuap! 361g » pue paloig ayey Aeg 1e}0, ewen aeXojdwy (on) (6) suojonpeq (8) w @) ) ayeq pueAeq = () ni 010z-2z0-PL00-z-e #NId podiy sexs qog Aemixe uoRes07 pure eloig W-2S8I-LLD #JORQUOD ZbOz ‘2 48q0}90 ] Buipua year Joy | wequinn jouxed TLSZE ePUOLY "808d "PEOH Piel Jeouads Isa S23] ssauppy, [ ~ou) ‘suuey Aydin ] WEN S10}9eIjU0D san {psooay JNOY pue oben, uoyoruysuog 669-010-002 Lve-HM STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE 10/11/12 I, HELEN H PORTER PRESIDENT (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION (Name of signatory party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by PORTER CONSTRUCTION COMPANY, INC. on the 3-12-0016-022-2010 C11-1852-AP Bob Sikes Airport Taxiwny A Rehab. (Contractor or Subcontractor) that during the payroll period commencing on the 4TH day of and ending the 10TH 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 PORTER CONSTRUCTION COMPANY, INC. from the full weekly {Convair or 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 REMARKS: (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 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 [x _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: NAME AND TITLE SIGNATURE HELEN H PORTER, PRESIDENT HY Qt Raton THE WILLFUL