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

0,00 0.00 0.00 is 0,00 $0.00) $ : Q 0.00 0.00 0.00 Ss 0.00 $0.00) $ ~ lo 0.00 0,00 0.00 3 0.00 $0.00] $ : lo 0.00 0.00 0.00 s 0.00 $0.00! $ : a 0.00 0.00 0.00 8 0.00 $0.00] $ : lo 0.00 0,00 0,00 s 0.00 $0.00} $ : A Division of Seutakll Company Past Office Boa I528 Lake City, H 32056 (S86) T52AIT faa (SSO) (52ME52 CW Roberts Contracting Post Office Boa 188 Hasfoul, FL 32334 RE: Destin Aiport ~ Runway 14 32 Rehabilitation ~ Okaloosa County, FL Sa Whom Ft May Concoin: We did not pexfoum any wark on the above mentioned project from weels ending 02]15]13 until week ending 03/08/13. We have submitted tue. certified payrolls for this project which are: Payroll #1 — Week ending 02/15/13 Payroll #2 — Week ending 03/15/13 Gil other weeks ave nan-perfounance with the week ending 03/75/13 being the final payroll fon this project. Tf you have any questions or need additional clenification, please call me at 386-752-0141, STATEMENT OF COMPLIANCE 2 —_ 4 4 Cry _ Customer CW ROBERTS CONTRACTING Jab $00015 C W ROBERTS DESTIN AIRPORT DATE 3/22/13 Payroll # - 1 County OKALOOSA i, BEVERLY §. PITTMAN PARDEE OFFICE MANAGER/PAYROLL do hereby certify under penalty of perjury: (1) That I pay or supervise the payment of the persons employed by PENHALL CO - SGG Florida on the ABOVE PROJECT; that during the payroll period commencing on the 9 day of February,2013 and ending the 15 day of Pebruary, 2013 all persons employed on the said project hava 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 PENHALL CO - SGG Florida from the full weekly wages earned hy 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 Sub- title A), issued by the Secretary o£ Labor under the Copeland Act, as amended (48 Strat. 948,62 Stat. 108,72 Stat. 967, 76 Stat. 357,40 U.S.C. 3145}; and described below: Federal Tax, State Tax, State Disability, Wage Garnishments(court order), FICA/Medicare, direct deposits/loans, and uniforms. (2) That any payroils otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rate for laborers or machanics contained therein are not less than the applicable wage rates contained in any that the classification aet forth therein for each laborer or mechanic con- wage determination i ted into the ? form 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, ox if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) Thats (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 Bach 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 EXCEPTIONS (CRAFT) EXPLANATION Remarks a Z Name and Title: va ie OFFIC) IAGER/ PAYROLL, Signature wins of any of the above statements may subject the contractor or subcontractor to civil or ee section 1001 of title 18 and section 231 of title 31 of the United States code. The willful tainteicntho criminal prosecutioné / PENHALL CO - SGG Florida 01 087 DATE 3/21/23 TPRA94 631 SE Industrial Circle TIME 5.43 PAGE 1 Lake City FL 32025 306-752-0141 Fed ID # 33-0349226 PAGE 2 OF J“ PAYROLD NO. 0002 CERTIPIED PAYROLL REPORT WEEK ENDING DATE - 2/15/13 Job 600015 C W ROBERTS WAGE DECISION NO. DESTIN AIRPORT Contract Lic. CONTRACT START DATE 2/09/13 REHAB RUNWAY 14 32 OKALOOSA COUNTY, FL CUSTOMER 18356 CW ROBERTS CONTRACTING 160 INDUSTRIAL PARK ROAD FREEPORT PL (32435 : -- THIS Job -- ------ THIS WEEK MEDIC cone ence rene HOURS WORKED THIS Joh = ----------- TX TVL CHK DATE PICA spi NAME, 8 af 2s af af af ae af NTX TVL BENEFITS FED W/T UNION ADDRESS E MIN og 10 i 12 13 5D 15 TOT TY PAY ‘TX ADJ SCK PAY ST W/T OTHER ZIP CODE/ SOCIAL SECH/ EXM/EMPH X CDE SAT SUN MON TUE WED THU FRI HOUR HR RATE NTX ADJ TOT PAY LOC W/T SUT W/T 17.65 COMER, HILLY C, GRINDNG/CR M 0 +09 3.50 1.00 .00 .00 .00 00 4.50 ST 28.280 -00 0622213 160,99 00 +00 00 100 © 544.29 100 00 00 00 00 40.50 808s 00 -00 127.26 +00 00 02 14535 PRD 500 225 REDUCTION 40.50 Job TOTALS 7+ +--+ -POTAL HOURS THIS WEEK ------- TOT TY HRS BR 00 3.50 2.00 -00 00 +00 00 4.50 ST .00 OV 00 OF vot te ee TOTAL DOLLARS THIS WBREK----------5- 2s --e TX TVL NTX TVL TX ADI NIX ADI BENEFITS HOL PAY SICK PAY TOTAL PAY 00 +00 -00 00 00 00 127.26 MINORITY CODES 0-CAUCASTAN 2~AFRICAN-AMERICA 2-~ASIAN 4-ANERICAN INDIAN 4-HISPANIC §-PACIFIC ISLANDR 6-OTHER ‘TOT PAY TOT DED NET PAY CHECK # 2812.11 783.43 2028.58 431999 Deduction Kes {as Reduction = Coreur Heelt+h, Life aa a de ‘4 Yen \ P fe aa) j wVvy S 263 Ps DATE 3/21, Division Company 3 JPRESI4 TOTALS H/R BEN TOTALS H/R BEN 100 00 +00 MINORITY CODE AMSuUNnEG 01 087 PENHALL CO - SGG Florida 631 SB Industrial Circle Lake City FL 32025 386-752-0142 CERTIFIED PAYROLL REPORT - + > -TOTAL HOURS THIS WEEK ------- TOT HRS 3.50 2.00 -00 +00 00 00 4.50 00 00 see e+ - POTAL DOLHARS THIS WEEK~--- = NTX TYL TH ADI NTX ADJ BENEFITS HOL PAY +00 00 00 00 -POTAL HOURS THIS WEEK +--+ --5 vor HRS 3.50 1.00 00 00 00 +00 4.50 00 00 - oo +e ePOTAL DOLLARS THIS WHREK----- NTX TVL TX ADS NTX ADT BENEFITS HOL PAY +00 +00 +00 00 DESCRIPTION CAUCASIAN AFRICAN-AMERICA ASIAN AMERICAN INDIAN HISPANIC PACIFIC ISLANDR OTHER TIME 5.43 #SEX ENDING SICK PAY TOTAL PAY 00 127.26 SICK PAY TOTAL PAY +00 127,26 PAGE 2 2/15/13 STATEMENT OF COMPLIANCE Customer CH ROBERTS CONTRACTING Job 600015 C W ROBERTS op DESTIN AIRPORT eae DATE 3/24/13 Payroll # - —~3-+ County OKAS.00SA I, BEVERLY S. PITTMAN PARDEE OFFICE MANAGER/ PAYROLL do hereby certify under penalty of perjury: (1) That 1 pay or supervise the vayment of the persons employed by PENHALL CO - SGG Florida on the ABOVE PROJECT; that during the payroll period commencing on che 23 day of February,2013 and ending the i day of March,2013 all persons employed an the said project have been paid the full weekly wages earned, that no rebates have been or will he made either directly or indixectly to or on behalf of said PENHALL CO - SGG Florida from the €ull weekly wages earned by any person and that no deductions have been made either directly or indirectiy fram the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR sub- title A), issued hy 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: Federal Tax, State Tax, State Disability, Wage Garnishments{court order}, FICA/Medicare, disact deposits/loans, and uniforms. {2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rate or 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 con- form with the work he perfermad. 13) 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 PRINGE 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 ccntract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4{c) below. (>) WHERE FRINGE BENEFITS ARE PAID IN CASH X ach laborer or mechanic listed in the above referenced payroll has an amount not less than the sum of the applicable basic hourly wage benefits as listed in the contract, except as woted in Section 4{c) heen paid as indicated on the payroll, rate plus the amount of the required fringe below, fc} EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION Remarks f --NON PERFORMANCE"), / *. BEVERLY S. BUT TWAN /PARDEE OFFICE MANAGER/PAYROLL --NON PERFORMANCE! The willful falsification pt any of the above statemenrs may subject the contractor or subcontxactoxr to civil or criminal prosecution. S¢e section 1001 of title ia and section 231 of title 31 of the United States code. 01 087 PENHALL CO - SGG Florida DATE 3/14/13 JPRI94 631 SE Industrial Circle TIME 21.32 PAGE «29 bake City FE 32025 4 386-752-0141 Fed ID # 33-0349226 fe PAGE 1 OF PAYROLL NO. -0603; NON- PERFORMANCE REPORT WEEK ENDING DATE - 3/01/13 Job 600035 C W ROBERTS WAGE DECISION NO. DESTIN AIRPORT Contract Lic. CONTRACT START CATE 2/09/13 REHAB RUNWAY 24 32 OKALCOSA COUNTY, FL CUSTOMER 18356 CW ROBERTS CONTRACTING 16G INDUSTRIAL PARK ROAD FREEPORT FL 32433 -- THIS Job -- ------ THIS WEEK MEDIC cree renee HOURS WORKED THIS dob = ----------- TX TVL CHK DATE PICA SDI TOT PAY NAME s 2s 2/ at af af af va NTX TVL BENEFITS FED W/T UNTON TOT DED ADDRESS: EMIN 23 24 25 26 27 28 Gl TOT TY PAY TX ADT SCK PAY ST W/T OTHER NET PAY ZIP CODE/ SOCIAL SzC#/ EXM/EMPA X CDE SAT SUN MON TUE WED THU FRI HOUR HR RATE NTX ADT ‘TOT PAY Loc W/T SUT H/T CHECK 4 Job TOTALS soe ee TOTAL HOURS THIS WEEK ------- zor TY HRS BR -00 oo a9 +00 00 08 00 00 ST og ov a0 oT see ee ee ee TOTAL BOLLARS THIS WEEK ---- +--+ e557 tr tee TX TVE NPX TVL TA ADI NTX ADT BENEFITS HOL PAY SICK PAY TOTAL PAY .00 100 +00 +00 00 00 00 MINORITY CODES 0-CAUCASIAN L-AFRICAN-AMERICA 2-ASIAN 3-AMERICAN INDIAN 4-HISPANIC 5-PACIFIC ISLANDR 6-OTHER 4 2; bss STATEMENT OF COMPLIANCE Customer CY ROBERTS CONTRACTING Job 600015 C W ROBERTS DESTIN AIRPORT 4 & DATE 3/21/13 Payroll # - 0 ie County OKALOOSA I, BEVERLY S. PITTMAN PARDEE OFFICE MANAGER/PAYROLL do hereby certify under penalty of perjury: (1) That I pay or supervise the payment of the persons employed by PENHALL Co - SGG Florida on the ABOVE PROJECT; that during the payroll period commencing on the 9 day of March,2013 and ending the 15 day of March, 2013 all persons employed on the 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 behalé of said PENHALL CO - SCG Florida from the £ull 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 Sub- ticle A), issued by the Secretary af 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: Federal Tax, State Tax, State Disability, Wage Garnishments(court order}, SICA/Medicare, direct depasits/loans, and uniforms. {2) That any payrolls otherwise under this contract required to be submitted for the above period