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

Hlth-E-CWR » Hith-F-CwR ’ Hith-EC-CuR » HLth-ES-CWR « 403K CHR » Loan #1 » Mise ’ {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 and 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 for each laborer or mechanic conform with the work 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 | Vo In addition to the basic hourly wage rates paid to each laborer ar mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the comtract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4{c) below. ** SEE ATTACHED BENEFIT SHEET ¥* (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 rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Sectiond4{c) below. (c) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION Fina Remarks: af. NAME AND TITLE ae) Pa ,EEO OFFICER HA NOY a SHARON MACKEY j THE WILLPUL 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. Page - 49 56172 C. W. Roberts Construction Date - 3/28/13 Period End - 03/17/13 Certified Payroll Report w/Fringe Info €.W. Roberts Contracting, Inc. Period No. - 06 3372 Capital Circle NE TallahassePL 32308 Job No.: 1511078 Destin Aiport Rehabilitate Runway 14-32 Okaloosa County Soc.Sec.No FMS Dep S$ Cat Mn Craft Step Regular. . .. . Overtime . . other Total Job +... Check Detail. Name/Address Wrk Date Hours Rate Hours Rate Hrs. Hours Amount. Description Amount: -Fringe Benefits- XXX-XX-3217 M 1M 003 01 Joi0 Christopher s. Davis 03/12/13 8.00 22,500 8.00 180.00 87006 03/13/13 8.00 22.500 8.00 180.00 Gross Pay 1,075.00 weer eee --- - FED Income T 94.64 Superintendent 16.90 16,00 360.00 PED FICA w/h 60.76 FED Medicare 14.221 H1th-F-CHR 95.00 ABLAC-STD 734 401K CWR RTH 46.00 CHR 401KR 0% 18.00 Net Pay 749.05 Male White (Not of Hispanic Davis, Christopher s. EXX-XX-9770 8 M 007 01 1250 Robin A. Hivner 03/13/13 a7019 03/14/13 707.97 Teaety sae 88.06 Broom/Sweeper Op-80H2-on—Less 6.50 2.00 8.50 221,64 FED FICA w/h 43.13 FED Medicare 10.09 AmDental ESH 12.26 401K CWR 28.32 CWR 402KP 0% 14.16 Male White (Not of Hispanic Net Pay §11,95 Hivner, Robin A. 6.50 2.00 XXX-KX-3084 S F 007 01 2042 Velma L. Sasnett 03/23/13 4.50 11.000 4.50 49.50 87054 - meee nen -- -- Gross Pay 671.00 Dump Truck Driver 4.50 4.50 49.50 FED Income T 73.14 FED FICA w/h 36.40 FED Medicare 8.51 Hith-EC-CWR 70.00 AmDental ECH 13.89 Life - Cinn 2.24 Net Pay 466.82 Female White (Not of Hispanic Sasnett, Velma L. Destin Aiport Destin Airport E-Verify Job #1511078 Checked Employee xX Adams, Douglas xX Adams, Jawarski X Albers, David X Allen, Carlos xX Aubry, Edgar x X xX X X Beasley, John Beasley, Tambra Bernal, Carlos Brown, Herman Brown, Jeffery xX x xX X x x xX x x xX x xX xX x KK KK RK KK KK OX xX xX xX x xX x x xX x xX x x x «x x x > Faircloth, Phillip Brundidge, Emanuel Bryan, Lucas Bullock, Richard Burleson, Ronnie Campbell, Dwayne Clift, Adam Cramer, Lance Crittenden, Curtis Crowe, Dereck Davis, Christopher Dennie, Fadrekus Edwards, Anthony Eikeland, John Feulner, Kenneth Frazier, Kiko Sr, Garrett, Richard Gatlin, Jerry Gibson, Devin Gill, Robby Golleher, Robert Gossman, Barry Gray, Willie Jr. Gregory, Jack Harrell, Alan Harris, John Harris, LaWayne Hill, Gregory Hivner, Robin Hubbard, William Hunter, Richard Hyatt, Christopher Jackson, Freddie Jacobs, Travis Jason, Carswell Jones, Michael King, Nathaniel Kirkpatrick, Anthony Kruger, Timothy Kucinski, Joseph Langston, David Lemmon, Brian ee Mahone, David Martin, Larry Mathews, Roy McMillan, Steven Messer, Dale we GeéeN - NOT Te eVicn sly su br Her . Nell, Bobby Norman, David Oliver, Lorenzo Parham, Armond Patterson, James Pennewell, Zachary Phillips, Ramona Pitts, Kelsey Powell, Andrew Rodriquez, Michael Rutherford, Raymond mi RK OR OO OK OE OK Oe EK Sasnett, Velma Scott, Billy Scott, Billy Sheets, Jeffery Smith, Jodi Stanley, Alphesus mM MK mM OE Stanley, Steven Stanley, Thomas Stone, Roy Jr. Street, Jerry Street, Leverne Street, Tony Tate, Donald Tate, Stephen Thornton, Alfred Tillis, bobby Tucker, Christopher x x X X xX x x x X Xx x Williams, Chivas Williams, Eddie Wilson, Tyler Yon, Johnnie Young, Terry ~~ MM OK KE SENSITIVE BUT UNCLASSIFIED Page 1 of 2 Department of Homeland Security E-Verify Report Prepared: 03/07/2013 Page: 1 of 1 Case Verification Number: 2013066091208UG Case Information: Employee Information: Last Name: Baggett First Name: Adam Middle Initial: Cc Maiden Name; Social Security Number: ae RE OGIO Date of Birth: 08/10/1991 Citizenship Status: A citizen of the United States Document Information: List B Document: Driver's license or ID card issued by a U.S. List C Document: Social Security Card state or outlying possession Document Name: Driver's license Document State: Florida Driver's License or ID Card 539993912900 Document Expiration Date: 08/10/2013 Number: Alien Number: 1-94 Number: Additional Information: Hire Date: 08/09/2010 Employer Case ID: . Federal Contractor with FAR E- Verify . Three-Day Rule Reason: Clause verifying an existing employee Three-Day Rule - Other: Submitted By: TMCK5391 Submitted On: 03/07/2013 Initial Case Result: Case Result: Employment Authorized Employee Referred to SSA: Referred By: Referred On: Case Result from SSA (after SSA Tentative Nonconfirmation): Case Result: Response Date: Resubmitted to SSA (after Review and Update Employee Data): Last Name: First Name: Middle Initial: Maiden Name: Social Security Number: Date of Birth: Resubmitted By: Resubmitted On: Case Result from SSA (after Resubmission): Case Result: Request Name Review: Comments: Submitted By: Submitted On: Case Result from DHS (after DHS Verification in Process): Case Result: Response Date: Employee Referred to DHS: Referred By: Referred On: Case Result from DHS (after DHS Tentative Nonconfirmation): Case Result: Response Date: Photo Matching Results: Determination: https://e-verify uscis.gov/emp/BpCaseDetailsLetter.aspx?Case VerNum=2013066091208UG 3/7/2013 Page 2 of 2 Employee Referred to DHS (Additional): Referred By: Referred On: Case Result from DHS (after Additional DHS Tentative Nonconfirmation): Case Result: Response Date: Case Closure: Closure Statement: Closed On: Closed By: SENSITIVE BUT UNCLASSIFIED https://e-verify .uscis.gov/emp/BpCaseDetailsLetter.aspx?Case VerNum=2013066091208UG = 3/7/2013 SENSITIVE BUT UNCLASSIFIED Page | of 1 Department of Homeland Security E-Verify Report Prepared: 03/07/2013 Page: 1 of 1 Case Verification Number: 2013066091523YF Case Information: Employee Information: Last Name: Baskins First Name: Barbara Middle Initial: A Maiden Name: Social Security Number: etek EE 1890 Date of Birth: 03/12/1954 Citizenship Status: A citizen of the United States Document Information: List B Document: Driver's license or ID card issued by a U.S. state or List C Document: Social Security Card outlying possession Document Name: Driver's license Document State: Florida Driver’s License or ID Card Number: 6252063545920 Document Expiration Date: 03/12/2015 Alien Number: I-94 Number: Additional Information: Hire Date: 01/28/2002 Employer Case ID: Threa-Day Rule Reason: Federal Contractor with FAR E-Verify Clause verifying Three-Day Rute - Other: an existing employee Submitted By: TMCKS391 Submitted On: 03/07/2013 Initial Case Result: Case Result: Employment Authorized Employee Referred to SSA: Referred By: Referred On: Case Result from SSA (after SSA Tentative Nonconfirmation): Case Result: Response Date: Resubmitted to SSA (after Review and Update Employee Data): Last Name: First Name: Middle Initial: Maiden Name: Social Security Number: Date of Birth: Resubmitted By: Resubmitted On: Case Result from SSA (after Resubmission): Case Result: Request Name Review: Comments: Submitted By: Submitted On: Case Result from DHS (after DHS Verification in Process): Case Result: Response Date: Employee Referred to DHS: Referred By: Referred On: Case Result from DHS (after DHS Tentative Nonconfirmation): Case Result: Response Date: Photo Matching Results: Determination: Employee Referred to DHS (Additional): Referred By: Referred On: Case Result from DHS (after Additional DHS Tentative Nonconfirmation): Case Result: Response Date: Case Closure: Closure Statement: Closed By: Closed On: SENSITIVE BUT UNCLASSIFIED hitps://e-verify.uscis.gov/emp/BpCaseDetailsLetter.aspx?Case VerNum=201 3066091523 YF 3/7/2013 Page | of 1 SENSITIVE BUT UNCLASSIFIED Department of Homeland Security E-Verify Report Prepared: 03/07/2013 Page: 1 of 1 Case Verification Number: 2013066091754WZ Case Information: Employee Information: Last Name: Brown First Name: Travis Middle Initial: c Maiden Name: Social Security Number: #RE HE 8927 Date of Birth: 05/21/1979 Citizenship Status: A citizen of the United States Document Information: List B Document: Driver's license or ID card issued by a U.S. state or List C Document: Social Security Card outlying possession Document Name: Driver's license Document State: Florida Driver’s License or ID Card Number: B650803791810 Document Expiration Date: 05/21/2020 Alien Number: 1-94 Number: Additional Information: Hire Date: 04/19/2010 Employer Case ID: ‘Three-Day Rule Reason: Federal Contractor with FAR E-Verify Clause verifying Three-Day Rule - Other: an existing employee Submitted By: TMCK5391 Submitted On: 03/07/2013 Initial Case Result: Case Result: Employment Authorized Employee Referred to SSA: Referred By: Referred On: Case Result from SSA (after SSA Tentative Nonconfirmation): Case Result: Response Date: Resubmitted to SSA (after Review and Update Employee Data): Last Name: First Name: Middle Initial: Maiden Name: Social Security Number: Date of Birth: Resubmitted By: Resubmitted On: Case Result from SSA (after Resubmission): Case Result: Request Name Review: Comments: Submitted By: Submitted On: Case Result from DHS (after DHS Verification in Process): Case Result: Response Date: Employee Referred to DHS; Referred By: Referred On: Case Result from DHS (after DHS Tentative Nonconfirmation): Case Result: Response Date: Photo Matching Results: Determination: Employee Referred te DHS (Additional): Referred By: Referred On: Case Result from DHS (after Additional DHS Tentative Nonconfirmation): Case Result: Response Date: Case Closure: Closure Statement: Closed On: Closed By: SENSITIVE BUT UNCLASSIFIED https://e-verify .uscis.gov/emp/BpCaseDetailsLetter.aspx?Case VerNum=201306609 1754WZ 3/7/2013 Page | of | SENSITIVE BUT UNCLASSIFIED Department of Homeland Security Report Prepared: 03/07/2013 E-Verify Page: 1 of I Case Verification Number: 2013066092159TR Case Information: Employee Information: Last Name: Hanna First Name: Samuel Middle Initial: Maiden Name: Social Security Number: Hk FH AG 1B Date of Birth: 12/13/1963 Citizenship Status: A citizen of the United States Document Information: List B Document: Driver's license or ID card issued by a U.S. state or List C Document: