Okaloosa County BOCC — 2013 meeting #1141 (date undetermined) — CW Roberts DTS Rehab RW 14_32 Final Certified Payroll — reading text

the payroll of 02/43/2013 to 02/19/2013 al! persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made elther directly or indirectly from the full wages earned by any person, other than permissible deductions, as described below: FICA (Sacial Security}, Medicare, Federal Income Taxed, State Income Taxes, State Disabillty (SDI), Court Ordered Wage Altachments, 401K Plans, Cafeterla Plan (125) 3) That any payroils otherwise under this contract requlred to be submitted for the above perlod are correct and complete; that the wage rate for laborers or mechanics contained therein are not less than the applicable wage rates contalned 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. 4) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency. 5) 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 the appropriate programs for the benefit of such employees. f] b) WHERE FRINGE BENEFITS ARE PAID IN CASH \ (A) Each taborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not Jess 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 5{c) below: c) EXCEPTIONS EXCEPTION (Trade) EXPLANATION Fail J. posvnel Remarks _hiwatepleas lubed C2. Naiie and Title * Signature Or prema - U.S. Department of Labor Wage and Hour Division PAYROLL (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Rey, Dec. 2008 ua rane unit Howe iets OMB No.:1235-0008 NAME OF CONTRACTOR[X] OR SUBCONTRACTOR [ } ADDRESS Expires: 01/34/2018 Ryles Grassing LLC FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO, PAYROLL NO. Destin Airport 2 02/19/2013 DESTIN AIRPORT NAME AND INDIVIDUAL IDENTIFYING NUMBER | NO. Of - ‘ NET (2.q., LAST FOUR DIGITS OF SOCIAL SECURITY| WITHH- Wed [tha | Pi] Sat Su] Men | Tue RATE GROSS WITH: | Slale wilh WAGES NUMBER) OF WORKER eLBING WORK wf i | | 6 | 7 f ta | OF PAY AMOUNT HOLDING | holding tax TOTAL PAID TIONS | CLASSIFICATION HOURS WORKED EACH DAY Total EARNED FICA TAK OFHER | DEDUCTIONS | __For WEEK Cc arranza, Richard E 96,00 XXX+-XX-O341 1 . 4 Ado on CS OR De BEC 28,271 42.14 (lt on cM oe) 77,02 378.98 LI. V\ LABORER ag sao! 42,0000 466.00 , : ; Ci illo, | wo8028 | 0 fosreras ne rao FR «ss let acd =O) (ia})SStté(<is«é‘aS*«<ati‘(isé‘ St‘ A SO 28,271 29.64 00} 6.61 -00} 64.52! 391.48 ve nN \ LABORER 8.00] 8.00 42.0000) 456.00] Dotson, Kevi noeocs0R2 5 [GENERAL ee ; a ae (g--)-=5 6 aa bere sO (tee eee 52.70 56,32 00} 12.33 00! 121,35 728.65 ive) 1a) LABORER 8.00 8.00] 24.2500) 850.00 Gonzalez, Joel 430.00! HO-KK B44 ‘ tloenera, = Pf ° 38.28 66.43) «==... oo} = 113.88! 503.82 H iY LABORER 10.00 wooo 43, Qa ag 617.50 " " , ‘ , . , Marl lartinez, Hector 455.00 1O-XX-267 1 4 45.65, 27.66 00) 10.68 00 83.99 652.28 LABORER 10.00 10.00] 15,5000! 736,25) . . ° . . . , Martinez, Javier XXX-XX-GG23 4 GENERAL 40.00 RAL peer pan 41,23) 20.54 OO] 9.64 .00} 71.41 593.59 LABORER 10.00) 10.00) 44.0000} 665.00 Perez, mone 3000 r 5 | habe ; 41.29 51.071 00) 9.64 .00) 101.94 $63.06 tr j a LABORER 10.00) 19.00] 14,0000) 665,001 Ri y ivera, Jose ; 130,00 XKK-KX 1638 ak x) 1 38,28 68.45) 00} 8,95) ie) 113.68} 503.82 ey { LABORER 10,00] 19.00) 43,0000) 617.50 700-010-68 w . 1 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Gormpliance: DATE 2113/2073 {c) EXCEPT EXCEPTION (CRAFT EXPLANATION L Rhonda Marchman CFO (Name of signatory party) (Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by Destin Airport, Okaloosa Cty, FL. Gustin, Cothern & Tucker, Inc. on the (Building or work) (Contractor or Subcontractor) that during the payroll period commenc 28 day of January, 2013 and ending the 3. dayof February, 2013 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 behaif of said Gustin, Cothern & Tucker, Inc. (Contractor 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 Subiitle 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 Aeteaeheol Pon Za As Cae, leds cbs. vi from the full weekly REMARKS: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and completa; 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 empfoyed in the above period are duly registered in a bona fide program regi Win @ olale appreniicesnip agency recognized by Ine sureau oF Apprenticeship and Training, United States Dapartment of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Depariment of Labor. (4) That: a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS fn addition te 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 machanic 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 Rhonda Marchman, CFG Aleve f [pcb 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. WH-347 Wage and Hour Record: 700-010-69 121 Hart Street, Niceville, FL_32578 _| Construction 2/1 Contractor's Name Gustin, Cothern & Tucker, Inc. Address Payroll Number: (2p) For Week enaing February 3, 2013 Contract # AS11076 |1078-5 Destin Alport Runway 14-32 FING ° f ay oF (6) o , ia) mployee Maris Tat Pay Rata! Project let Wages. Totat from and 4 Digit Identifier Hours Gross/ [FICAMWeekly| With MED- Total Paid for weak | Fringe Benefit (8 digit SS and full address Weokly holding | JGARE/ Deductions Sheet required on contracts Let Ry (3) Gross tax! {Weakly Gross (attached) prior to 1/49/09) Exemptions / [Work Classit- Weekly Wages) Race &Gender| ication Gross Robert Freeman 30 0) 0.00 23.18 | 278.10 4108) Grade wit, Checker |S 18.00 | 15.45 | 610,28 $37.84| $76.64 $243.22] $ 361.06 Michael Stona M4 lo 3,00 26.25 | 306.25 _| 4130) Grade wins Checker |S 43.00 | 17.50 | 1,041.25 13 64.56 [ % 106.041 $ $185.70| $855.55 William Wall Lt o 0,00 21.60 | 259.20 7940) Grade Wit Checker {5 18.00 14.40 566.80 | $ 36.38 (S$ 44.62 (5 $126.57 $ 460.23 io o.00 0,00 0.00 Ss 0.00 $0.00) $ - fa) 0,00 0.00 0.00 gj 0.00 $0.00} $ : fo ooo | 0.00 0.00 s 0.00 $0.00! $ : (e) 0.00 0.00 0.00 is 0.00 $0.00) $ = a 9.00 | 0.00 300 s 0,00 $0.00 $ - lo 0.00 0.00 0.00 is 9.00 $0.00| 5 - O 9.08 0.00 6.00 is ¢,00 $0.00; $. z te) 0.00 0.00 0.00 S 0.00 $0.00} $ “ Deductions Record: 700-010-69 Construction Contractor's Name f Gustin, Cothern & Tucker, Inc. | Address[ 121 Hart Street, Niceville, Fl 32578 Payroll Number 4 | For Week Ending 2/3/2013 Contract # 1511078 FIN# 159-28641268 Project and Location Oestin Airport, Okaloosa Cty, FI | 02/11 Type a Deduction description in each box and then record the amount of that Deduction for each emplayee (or leave blank}. Employee Name (fast, first) Health insurance United Dental Total Deductions Amount Freeman, Robert $110,89 $15.00 $125.89 Stone, Michael $0.00 Wall, William $29.49 $7.57 $37.06 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 STATE OF FLORIOA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE 2/28/2013, {c) EXCEP1 EXCEPTION (CRAFT EXPLANATION [, Rhonda Marchman cro (Name of signatory party) (Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by Gustin, Cothern & Tucker, Inc, on the Destin Airport, Okaloosa Cty, FL (Contractor or Subcontractor) : (Building or work} that during the payroll period commenc 4 day of February, 2013 and ending the 10 _dayof February, 2013 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 behaif af said Gustin, Cothem & Tucker, Inc, (Contractor 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 U.S.C. 3145), and described below: from the full weekly REMARKS: See Altached Payroll for Deductions (2) That any payrofis otherwise under this contract required to be submitted for the above period are correct and camplete; that the wage rates for laborers or mechanies contained therein are not less than the icable wage rates in any wage ination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work ha performed. ‘That any apprentices employed in the above period are duly registered in a bona fide apprenucesnip program registerea win a State apprenucesnip agency recognizea oy the bureau or 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 Tralning, United States Department of Labor. (4) That: & WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer ot 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 SENEFITS ARE PAID IN CASH feo Teach 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 benafits as listed in the contract, except as noted In Section 4(c) betow: 31 OF THE UNITED STATES CODE. NAME AND TITLE SIGNATURE Rhonda Marchman, CFO, alr rt 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 700-010-69 WH-247 Construction 02/1 Wage and Hour Record: .