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

Contractor's Name { Gustin, Cothern & Tucker, inc. ] Address 121 Hart Street, Niceville, FL_ 32578 ] Payroll Number: [4] For Week Ending February 10, 2013 Contract # 1511078 |ioves Project and Location Destin Airport Runway 14-32 FING a) é (5) (3) 7) ctio! (9) (10) Emptoyee Name (4) Day and Date tots! |PayRate| Project | ae (8) Deductions Net Wages { Total from and 4 Digit Identifier wlwlwlmle.lsal suf Hous Gross/ [FICAMWeekiy} With- MED- 401k Total from Total Paid far weak [ Fringa Benafit (2 digit SS and full address: z Weekly holding | ICARE/ Deduction Deductlons Sheet required on contracts Let ®) (3) A Gross taxi | Weekly Sheat (Weekly Gross (attached) prior to 1/19/09) Exemptions / |Work Classit-1 $ Weekly | Gross (attached) Wages) Race&Genderg ication |Z] 24 1] os | 26 | 27 | me | 29 | 20 Gross Robert Freeman |____ 50 oO 4 3 13.00 | 23.18 | 741.60, | 4108) Grade Witt Checker {8 aa al 4.5) 2850 | 18.45 | 741.60 $45.05] $98.60} $10.75/$ = 1S 125.89 $279.22] $ 462.38 Michael Stone Ma. (e} ooo | 2025 | 17.50 | 4130 Grade |- Wi. Checker |S 1.00 17.58 726.25 | 8 46.03} 5 55.79 /$ 10.53 | $ 2 $ - $114.35] $ 614.90 Wiliam Wat | Mt o 4) 4 3 13.00 | 27.60 | 69120. | 7340 Grade WIM Checker {S a a 45 zasc | 14.40 | 69120 1$ 42.85|/$ 60.28|$ 10.02|$ $ 37.06 $150.21/$ 40.99 lo 0.00 0.00 0,00 Ss 0.00 $0.00| $ : lo 0.00 0.00 0.00 s 0.00 $0.00; $ : (a) 0.00 0.00 0,00 s 0.00 $0.00) $ z [e] 0.00 0.00 0.00 is a.00 $0.00} $ - lo 0.00 0.00 0,00 Ss 0.00 $0.00] $ - oO 0.00 0.00 0.00 Ss 0.00 $0.00] $ - lo 9.00 0.00_| 9.00 is 0.00 $0.00) $ ~ lo @.00 a.00 0.00 Ss 9.00 $0.00] $ : 700-010-69 Construction o2ft1 Deductions Record: Contractor's Name lL Gustin, Gothern & Tucker, inc. Address[121 Hart Street, Niceville, FL 32578 Payroll Number: ForWeek Ending] _—~—=a10/2013 Contract #] 1511078 §9-2861268 Project and Lecatfon[ Destin Alrpoct, Okaloosa Cty, FL. Supplemental FIN # ‘Type a Deduction description in each box and then record the amount of that Daduction for each employee (or leave blank). Health United Tatal Employee Name (last, first) Insurance | Dental WEEKLY Deductions Amount $125.89 Freeman, Robert $110.89 $15.00 Stone, Michael : $0.00 $37.06 Wail, William $29.49 $7.57 $0.00 $0.00 $0.00 $0.06 — $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 700-010-690 Canstructian oz STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD Statement of Compliance: DATE 2/28/2013 {c) EXCEPT CEPTION (CRAFT. EXPLANATION IL Rhonda CFO (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, 0: Cty, FL (Contractor or Subcontractor) (Building or work) that during the payroll period commenc 11 day of : February, 2013 and ending the 17__ day of February, 2013 all persons employed - on sald project have been paid the full weekly wages earned, that no rebates have been or wilt REMARKS: be made either directly or indirectly to or on behalf of said Gustin, Cotharn & Tucker, Inc. {Contractor ar Subcontractor) wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any parson, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subiitle A), issued by the Secretary of Labor under the Copeland Aci, 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 See Attached Payroll jor Deductions (2) That any payrolls otherwise under this cantract required to be submitted for the above period are correct and complete; that jhe wage rates for laborers or mechanics contained therein are not lass 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 program win a otaie app up agency by (ne Bureau oT United States Department of Labor, or if na such recagnized agency exisis United States Department of Labor. Apprenticeship and Training, Ina State, are registered with the Bureau of Apprenticeship and Training, (4) That: a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS Pain 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 madé 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 has bean 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 4(c) below: NAME AND TITLE. SIGNATURE Rhonda Marchman, CFO 31 OF THE UNITED STATES CODE. Vhernbe SV latelera 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 WH347 Construction O21 Wage and Hour Record: Contractor's Name —_ Gustin, Cothern & Tucker, Inc. i Address 421 Hart Streat, Niceville, FL_32578 Payroll Number: For Week Ending February 17, 2013 Contract # TS11078 |1078-5 Project and Location Destin Alrport Runway 14-32 FIN # «ty (5) 6} -{7} i (9) (10) Employee Name (4) __ Day and Date Total [Pay Rate} Project | ______ (8)__ Deductions Net Wages | Total from and 4 Digit Identifier wu! w|i e | sal su Hours Grossi {FICAMeckly| With- MED- 401k Total from Tatal Paid for week | Fringe Benefit (9 digit SS and full address i Weekly hofding | !GARE/ Deduction | Deductions ‘Sheet required on contracts Let 2) @) 5 Gross tax/ | Weekly Sheet (Weekly Gross (attached) prior to 1119/09) Examptions / [Work Classif-| 2 Weekly Grass {attached} Wages) Race&Gender| Ieation | 3 ana | 23 | ang | ans | ane | aiz Gross Robert Freeman so lo 0.00 | 23.48 | 247.20 Atos Grade wit Checker [S| 8 8 46.00 | 15.45 | 722.31 sas7a} 493.45| —$40.471$ + 1S 125.89 $274,591 $ 447.72 Michael Stone M4 lo 0.00 26.25 | 96.25 | 4130 Grade wit Checker |S 58 5.50 17.50 936.26 | $ seos{s 9020|/$ 1358/9 - 1S = $461.92|$ 774.33 William Wall A lo 0.00 | 21.60 | 239.40 7940 Grade waa Checker |S} 8 8 46.00 | 1440 | 49240 |[$ 2991/8 46.74) 699/$ - 1S 37.06 $120.70|$ 364.70 lo 0.00 0.00 0.00 Ss 0.00 $0.00| $ : fe] 5.00 0.00 6.00 Ss 0.00 $0.00] $ : | ee eee eel o 0.00 0,00 0.00 s 6.00 $0.00| $ : a 0.00 0.00 sco | Is 0.00 $0.00 $ : o 0.00 0,00 0,00 S. 0.00 $0.00] $ x jo. 0.00 0.00 0.00 Ss 0.00 $0.00} $ : fo} 0.00 0.00 0,00 5 0.00 $0.00] $ . ie] 0,00 6.00 0.00 s 0.00 $0.00] $ : 700-040-698 Construction 02/14 Deductions Record: Address[121 Hart Street, Niceville, Fl32578 _ | Contractor's Name | Gustin, Cothern & Tucker, Inc. | Payroll Number{ 6 ‘| For Week Ending 2117/2013 Contract # 1511078 FIN # [59-2861268 Project and Location{ __Dastin Aiport, Okaloosa Cy. Fi | Type a Deduction description in each box and then record the amount of that Deduction for each employee (or leave blank). . Totai Health United Deductions Insurance Dental Amount $125.89 $0.00 $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 Employee Name (last, first) Freeman, Robert $110.89 $15.00 Stone, Michael Wall, William $29.49 $7.57 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Statement of Compliance: DATE 2/28/2013 WAGE AND HOUR RECORD (c) EXCEPT XCEPTION (CRAFT EXPLANATION 700-010-69 Construction 0214 [, Rhonda Marchman CFO (Name of signatory party) (Title} do hereby state: (1) That | pay or supervise the payment of the persons employed by on the Destin Airport, Okaloosa Cty, FL Gustin, Cothern & Tucker, inc. {Contractor or Subcontractor) (Building or work) that during the payroll period commenc 18 day of February, 2013 and ending the 24 day of 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 & Tusker, 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: Piva f See Attached Payroll for Deductions (2) That any payrolls otherwise undar this contract required to be submitted for the above period are correct and compiete; that the wage rates for laborers or mechanics contained therein are not fess 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 a@apprenucesmip program /egisiered win 4 Slate apprenticesnip agency recognized oy [ne Hureau 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 [x 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: NAME AND TITLE SIGNATHRE Rhonda Marchman, cFd VOA MW ilom —. 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 Construction 421 Hart Street, Nicevilie, FL_32578 a Gontractor’s Name | Gustin, Cothern & Tucker, Inc. Address Payroll Number: For Week Ending February 47, 2073 Contract # TS11078 |1078-5 Project and Location Destin Airporl Runway 14-32 FINE a) @ @ i) fons (9) (10) Employee Name (4) Day and Date Total {PayRate| Project (8) Deduct Net Wages | Total from and 4 Digit Identifier wlqulwlalel|sal su} Hows Gross} [FICAMWeekly] With- WED- 401k Total from Total Pald for week | Fringe Benefit {9 digit SS and full address Weekly holding | ICARE/ Deduction Deductions Sheet required on contracts Let (2) (3) Gross tax Weekly Sheet (Weekly Gross (attached) prior to 1/49/09} Exemptions / |Work Classif-] ¢ Weekly Gross (attached) Wages) Race & Gender} feation 42] ans | ang | 20 | zat | 22 | 223 | 224 Gross Robert Freeman so oO 0.00 | 23.18 0.00 4108 Grade Win, Checker [8 0.00 15.45 $0.00) $ : Michael Stone M4 Of; 08. oso | 26.25 | 4130 Grade wim Checker |s| 8! 8.00 | 17.80 | 962.50 |$ 97.82] § 94,23 1396/8 - 1% - $166.01/$ 796.49 Witltarn Wall M4 oO 0.00 | 24.60 0.00 7340 Grade WIM, Checker {8 4.00 14.40 $0.00] $ : o 8.00 0.00 0,00 8 0.00 $0.00} $ : 0 0.00 0,00 0,00 s 0,00 $0.00] $ : t)