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

are correct and complete; that the wage rate for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incarporated into the contract; that the classification set zorcth therein for each Laborer or mechanic con- form with the work he performed. egistered (3) That any apprentices employed in the above period are duly registered in a hona fide ceship program 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) helow. {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 hasic 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 Signature i wr4 ny of the above statements may subject the contractor or subcontractor to civil or ection 1001 of title 18 and section 231 of title 31 of the United States code. The willful falsification if eriminal prosecution, e 02 087 PENHALL CO - SGG Florida DATE 3/22/43 JPRED4 631 SH Industrial Circle TIME 5.44 PAGE 1 —_ 4 ‘ . Lake City PL 32025 KS a, he” 386-752-0141 Fed ID # 33-0349226 vA | > PAGE 1 OF PAYROLL WO. dovs* CERTIFIED PAYRCLL REPORT WEEK ENDING DATE - 3/15/13 f i Job 600025 © W ROBERTS WAGE DECISION NO. , Fa] ¢ f DESTIN AIRPORT Contract bic. CONTRACT START DATE 2/09/13 [0 fe’ REHAB RUNWAY 14 32 vf OKALOOSA COUNTY, FL CUSTOMER 16355 CW ROBERTS CONTRACTING 160 INDUSTRIAL PARK ROAD FRERPORT FL = (32439 -- THIS Job ~~ ss--- THIS WEEK -~-------- MEDIC woe e eee ee HOURS WORKED THIS Job TX TVL CHK DATE FICA SDI TOT PAY NAME! 8 aso 3 Ves evs af NIX TVL BENEFITS FED #/T UNION =‘ TOT DED ADDRESS EMIN 09 16 2 12 13 pt 15 TOT TY PAY TX ADJ SCK PAY ST U/T OTHER NET PAY TOT PAY LOC W/T SUT W/T CHECK # ZIP CODE/ SOCIAL SEC#/ EXM/aMPH X CDE SAT SUN MON TUE WED THU FRI HOUR HR RATE NTX ADT 28.28 COMER, BILLY C. GRINDNG/GR M 0 00 .00 .00 ©.00 4,00 5.00 .00 9.00 ST 28.280 .00 932213 78.14 00 1450.88 GRINDNG/GR 00.00.00 «600.08 2.00 600-104 OV 42.420 -00 -00 288,80 00 425,72 +00 00 00 00 40.50 1125.16 8085 +00 +00 «296.94 +00 +00 435840 02 14535 PRD 500 125 REDUCTION 40.50 Job TOTALS wee ee - TOTAL HOURS THES WEEK --- > 7-7 = vor TY HRS HR 00 00 -00 00 4.00 6.00 00 9.00 ST 1.00 OV .00 (OT ee ee ee ee ee TOTAL DOLLARS THIS WEEK ---- 7577 t et TT TX Tvb NTX TVL TX ADS NTX ADS BENEFITS HOL PAY SICK PAY TOTAL PAY .00 00 +00 00 +00 00 296.94 MINORITY CODES 0-CAUCASIAN L-AFRICAN-AMERICA 2-ASIAN 3-AMERICAN INDIAN 4-HESPANIC 5-PACIFIC ISLANDR 6-OTHER * | fi Kes e Led chon & | Ded Reduction — (rove? Heel th ) Life Det tal femiumM Cx fa PENHALL CO - SGG Florida A of 3 , oa? f DATE 3/237 SPRP4A94 Fi 631 SE Industrial Circle Lake City PL 32025 386-752-0141 fa CERTIFIED PAYROLL REPORT oH rofl 2. Division TOTALS = = - + + - -TOTAL HOURS THIS WEH@&K----- 7 7 7 ror HRS oo oo oo co 4.00 6.00 00 9,00 1.00 00 eee te ee ee tte eH TOTAL BOLLARS THIS WEE K- -- <7 H/R BEN TK TV NTX TVL TX ADI NTX ADT BENEFITS HOL PAY 90 .00 200 00 00 company TOTALS s+ ee ee TOTAL HOURS THIS WES Ke - - - 7 7 ~ TOT HRS 00 oa Od 00 4.00 6.00 oo 9.00 1.00 .00 eee ee ee ee et TOTAL DOLLARS THIS WEE K- ---- H/R BEN TX TVL NTX TX ADS NIX ADT BENEFITS HOL PAY 200 00 00 00 00 .08 MINORITY CODE DESCRIPTION oO CAUCASIAN 1 AFRICAN-AMERICA 2 ASIAN 3 AMERICAN INDIAN 4 HISPANIC 5 PACIFIC ISLANDR 6 OTHER SICK PAY 00 SICK PAY 00 TIME 5.44 WEEK ENDING - TOTAL PAY 296.94 TOTAL PAY 296.94 PAGE a 3/15/13