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

000 000 000 000 000 900 000 16. 000 000 000 Pay Rate Job Total FWH OAS 504.00 MED SWH MI Other State: Other Pay: Total Ded: 21.000 14,000 FWH OAS 98.00 MED SWH MI Other State: Other Pay: Total Ded: 12.000 FWH OAS 144.00 MED SWH MI Other State: Other Pay: Total Ded: 14,200 FWH OAS 71.00 MED SWH MI Other State: Other Pay: Total Ded: 18.000 FWH OAS 288.00 MED SWH MI Other State: Page 2 Gross Wages Tax W/H 182,83 67,38 15.76 46,19 182.83 67.38 15.76 46.19 00 . 00 .00 148.58 58, 8& 13.77 40.37 00 00 00 182,83 67.38 15.76 46,19 00 00 00 148.58 58, 88 13.77 40,37 00 Net Pay 1086.80 774.64 1086.80 774.64 949.80 688.20 1086.80 774.64 949.80 688.20 Single (0) Sex: Male EEQ= White Class/Level/Skill: MAINTENANCE 50 Other Pay: Total Ded: 00 03/18/2013 2:04 pm Job 1304 Employee Address 072 SSN: GUSTAVISON, TIMOTHY D 1161 N. RICH RD. ALMA ,MI 48801 Single (0) Sex: Male EEO= White DESTIN AIRPORT Hrs, Type a > ew Class/Level/Skill: LABORER 30 034 SSN: RYDER, JR., ROGER D 216 W. POLK ST. 48847 ITHACA ,MI Single (0) Sex: Male EEO= White Suv co a AMERICAN STRIPING Certified Payroll Report For Pay Period Ending 03/16/2013 Group Code 0 WASHINGTON PAINTING Class/Level/Skill: LABOR/EQUIPMENT 60 072 SSN: GUSTAVISON, TIMOTHY D 1161 N. RICH RD. ALMA ,MI 48801 Single (0) Sex: Male EEO= White Su oO zw Class/Level/Skill: LABORER 30 072 SSN: GUSTAVISON, TIMOTHY D 1161 N. RICH RD. 48801 ALMA ,MI Single (0) Sex: Male EEO= White = oO = Class/Level/Skill: RUNWAY PAINTING 10 072 SSN: GUSTAVISON, TIMOTHY D 1161 N. RICH RD. ALMA ,MI 48801 =o Oo z 3/10 3/12) 3/42 3/13 3/14 = 3/15 3/16 *Sun* *Mon* *Tue* ‘*Wed* *Thu* *Frit *Sat* 3.000 1.000 12.000 4,000 4,000 5.000 12.000 Total 3 1. 000 000 12, 000 000 000 000 000 000 12, 000 000 000 000 000 000 000 000 000 000 000 000 Pay Rate Job Total 12.000 FHH OAS 54,00 MED SWH MI Other State: Other Pay: Total Ded: 24.000 FWH OAS 288.00 MED SWH MI Other State: Other Pay: Total Ded: 12.000 FWH OAS 48.00 MED SHH MI Other State: Other Pay: Total Ded: 14.200 FWH OAS 127.80 MED SWH MI Other State: Other Pay: Total Ded: 12.000 FWH OAS 144,00 MED SWH MI Other State: Page 3 Gross Wages Tax W/H 148. 58, 77 13 40. 58 88 37 00 . 00 .09 215. 75. 17. 51. 53 68 82 00 -00 .00 148, 58. 77 13 40. . 06 00 00 148. 58. 13, 4g, 00 00 00 148, 58. 13. 40, 598 88 37 58 88 71 58 88 77 37 Net Pay 949.80 688,20 1219,20 858,18 949.80 688.20 949.80 688.20 949 80 688,20 Single (0} Sex: Male EEO= White Class/Level/Skill: LABOR/EQUIPMENT 60 Other Pay: Total Ded: 00 . 00 03/18/2013 2:04 pm Job 1304 Employee Address 034 SSN: RYDER, JR., ROGER D 216 W. POLK ST, ITHACA ,MI 48847 Single (0) Sex: Male EEO= White Class/Level/Skill: 063 SSN: FRANKS, RODNEY D 319 N. MAIN ITHACA ,MI 48847 Single (0) Sex: Male EEQ= White Class/Level/Skill: 063 SSN: FRANKS, RODNEY D 319 N. MAIN ITHACA ,MI 48847 Single (0) Sex: Male EEO= White Class/Level/Skill Job Total 1304 DESTIN AIRPORT AMERICAN STRIPING Certified Payroll Report For Pay Period Ending 03/16/2013 Group Code WASHINGTON PAINTING Hrs. 3/10 3/11 3/12 3/13 Type *Sun* *Mon* *Tue* +Wed* R 12.000 0 D M LABOR/EQUIPMENT 60 R 0 1.000 D M LABORER 30 R 12,000 0 D M : LABOR/EQUIPMENT 60 kK Re Farnings ee KE Job Total 3255.80 Net Pay 2321.02 Hours 194.00 0 3/15 Frit 12.000 kok k Fed W/H SWH All States: LWEH: LWH All Locals: OASDI W/H Medicare Other State Pay Rate Total Job Total 12,000 16,000 FWH 12.000 OAS 000 480.00 MED . 000 SWH MI Other State: Other Pay: Total Ded: 000 21.000 FWH 1.000 OAS 000 21.00 MED 000 SWH MI Other State: Other Pay: Total Ded: 12.000 14.000 FWH 000 OAS 000 168.00 MED 000 SWH MI Other State: Other Pay: Total Ded: kk k tk 547.34 813,20 00 00 201.85 47,21 00 Page 4 Gross Wages Tax W/H 215,93 75.59 17.68 51,82 00 00 00 182.83 67.38 15.76 46,19 00 00 06 182.83 67,38 15.76 46,19 00 00 00 Net Pay 1219.20 858.18 1086.80 7714.64 1086 .80 774.64 AMERICAN STRIPING Page 1 03/25/2013 3:05 pm Certified Payroll Report For Pay Period Ending 03/23/2013 Group Code 0 Job 1304 DESTIN AIRPORT WASHINGTON PAINTING Employee Hrs. 3/17 /18 3/19 3/20 3/21 3/22 Pay Rate Gross Wages Address Type *Sun* on* *Tuet *Wed* *Thut *Frit *9at* Total dob Total Tax W/H = Net Pay 063 SSN: R 4,000 4,000 14.000. FWH 140.63 918.00 PRANKS, RODNEY D 0 000 OAS 56.92 668.12 319 N. MAIN D 000 56.00 MED 13.31 ITHACA ,MI 48847 N 000 SWH MI 39.02 Other State: 00 Other Pay: .00 Total Ded: .00 Single (0) Sex: Male EEO= White Class/Level/Skill: MAINTENANCE 50 5.000 14.200 FHE 140.63 918.00 063 SSN: R FRANKS, RODNEY D 0 000 OAS 56.92 668.12 319 N. MAIN D . 900 71.00 MED 13.31 ITHACA ,MI 48847 M 000 SWH MI 39,02 Other State: 00 Other Pay: .00 Total Ded: 00 Single (0) Sex: Male BEO= White Class/Level/Skill: RUNWAY PAINTING 10 5,000 16.200 EWH (173.38 1049.00 034 SSN: R RYDER, JR., ROGER D 0 , 000 OAS 65.03 750.80 216 W. POLK ST. D 000 81.00 MED 15.21 ITHACA ,MI 48847 M . 000 SWH MI 44,58 Other State: .00 Other Pay: 00 Total Ded: 00 Single {0} Sex: Male EEO= White Class/Level/Skill: RUNWAY PAINTING 10 4.000 16.000 FWH 173.38 1049.00 034 SSN: R RYDER, JR., ROGER D 0 000 OAS 65.03 750.80 216 W. POLK ST. D .000 64.00 MED 15.21 ITHACA ,MI 48847 M .000 SWH MI 44,58 Other State: 00 Other Pay: .00 Total Ded: 00 Single (0) 3ex: Male i0= White Tlass/Level/Skill: MAINTENANCE 50 Job =Total 1304 * * * * Harnings * * * # **# ke # Taxes * * * * Job Total 272.00 Fed W/H 314.01 Net Pay 1418.92 SWH All States: 167.20 Hours 18.00 LWEH: .00 LWH All Locals: 00 OASDI W/H 121.95 Medicare 28.52 Other State 00 * STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 17 13-Mar-13 12-0015 Rehab Runway 14-32 Destin Airport Date 11-Mar-13 Contract # 1078-3 i, Cathy Chapman, Admin Asst. do hereby state: Naine Title of individual signing (1) That I pay or supervise the payment of the persons employed by Bearden Construction Co., Inc on the Contract # 1078-3 that during the payroll period commencing on the 3rd day of March, 2013 and ending the 9th day of March, 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 behalf of said Bearden Construction Co., Inc from the full 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 Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Social Security Insurance Child Support Medicare Credit Union Allotment Federal Withholding Simple [RA (2) That any payrolls otherwise under this contract required to be submitted for the above are correct and complete; that the wage rates for laborers or mechanics contained therein are not less that the applicable wage rates contained in any wage determination incorp- orated 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 apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or ifno 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© below. (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 basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4© below. (c) EXCEPTIONS EXCEPTION (Craft) EXPLANATION REMARKS NAME AND TITLE SIGNATU: Cathy Chapman Admin Asst. Let ff A AOXIUY am) The willful falsification of any of the above statements may subject the contractor or “ypc to civiliop criminal prosecution. See Section 1001 of Title 16 and Section 231 of Title 31 of thé/United States Code. DD Form 879 Bearden Construction Company Inc Certified Payroll Report For the Period Ending: Job: 12-0015 Rehab Runway 14-32 Destin Air Destin, FL John D Fitch 03-03 03-04 03-05 03-06 03-07 03-08 03-08 Total XXX-XX-5082 Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours s-1 Laborer Reg 4.00 4,00 William A Hildebrand 03-03 03-04 03-05 03-06 03-07 03-08 03-09 Total XXX-XX-6770 Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours M- 0 Superintendent Reg 2.00 2.00 4.00 Bernard Jr Tingle 03-03 03-04 03-05 03-06 03-07 03-08 03-09 Total XXX-XX-0912 Caucasian Male Sun Mon Tue Wed Thu Fr Sat Hours M- 0 Superintendent Reg 2.00 2,00 Charles S Bryant 03-03 03-04 03-05 03-06 03-07 03-08 03-09 Total XXX-XX-5522 Black Male Sun Mon Tue Wed Thu Fri Sat Hours $- 3 Apprentice Reg 8.00 8.00 Totals for Rehab Runway 14-32 Destin Air 03-03-13 03-04-13 03-05-13 03-06-13 03-07-13 03-08-13 03-09-13 Total Sunday Monday TuesdayWednesdy Thursday Friday Saturday Hours 00 2.00 4.00 10.00 2.00 00 00 18.00 03-09-13 Cash Hrly Rate Fringe Fringe 17.50 Cash Hrly Rate Fringe Fringe 20,50 Cash Hrly Fringe Fringe Cash Hrly Rate Fringe Fringe 12.00 Gross This Job 70.00 70.00 Gross This Job 82.00 82,00 Gross This Job 42.50 42.50 Gross This Job 96,00 96,00 Gross This Job 290.50 03-11-2013 Total FWH SWH = Other Gross FICA SUI/SDI Deducts Net 700.00 69.38 87.95 493,93 48,74 Total FWH SWH = Other Gross FICA SUNSDI Deducts Net 820.00 78.34 32.36 648.39 60.94 Total FWH SWH Other Gross FICA SUIVSDI Deducts Net 850.00 79.50 46.93 663,06 61.54 Total FWH SWH Other Gross FICA SUISDi Deducts Net 432,00 8.33 290.74 109.63 25.30 Total Gross Deductions Net 2,802.00 FWH 233,55 41,915.01 FICA 196.46 SWH 60 SDI 00 Other 456.98 Page 6 STATEMENT OF COMPLIANCE PAYROLL NUMBER PAYROLL PAYMENT DATE CONTRACT NUMBER 18 20-Mar-13 12-0015 Rehab Runway 14-32 Destin Airport Date 19-Mar-13 Contract # 1078-3 I, Cathy Chapman, Admin Asst. _ do hereby state: Name Title of individual signing (1) That I pay or supervise the payment of the persons employed by Bearden Construction Co., Inc on the Contract # 1078-3 that during the payroll period commencing on the 10th day of March, 2013 and ending the 16th day of March, 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 behalf of said Bearden Construction Co., Inc from the full 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 Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948.63 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C, 276c), and described below: Social Security Insurance Child Support Medicare Credit Union Allotment Federal Withholding Simple IRA (2) That any payrolls otherwise under this contract required to be submitted for the above are correct and complete; that the wage rates for laborers or mechanics contained therein are not less that the applicable wage rates contained in any wage determination incorp- orated into the contract; that the classifications set forth therein