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

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 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 cach 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 Final REMARKS INAME AND SIGNATURE oo TITLE Ef j Ay ~ Cathy Chapman Admin Asst. PA AL LBV og The willful falsification of any of the above statements may subject the contractor or sub; sontractor to civil. dr criminal prosecution. y ; See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. DD Form 879 Bearden Construction Company Inc Certified Payroll Report For the Period Ending: 03-16-13 Job: 12-0015 Rehab Runway 14-32 Destin Air Destin, FL William A Hildebrand 03-10 03-14 03-12 03-13 03-14 03-15 03-16 Total Cash Hrly Gross XXX-XX-6770 Caucasian Male Sun Mon Tue Wed Thu Fri Sat Hours Rate Fringe Fringe This Job M- 0 Superintendent Reg 2.50 2.50 20.50 51.25 51.25 Totals for Rehab Runway 14-32 Destin Air 03-10-13 03-44-13 03-12-13 03-13-13 03-14-13 03-15-13 03-16-13 Total Gross Sunday Monday Tuesday Wednesdy Thursday Friday Saturday Hours This Job 00 .00 00 00 2.50 .00 .00 2.50 51.25 03-18-2043 Total FWH SWH = Other Gross FICA SUI/SDI Deducts Net 820.00 78.34 32.36 648.38 60.92 Total Gross Deductions Net 820.00 FWH 78.34 648.38 FICA 60.92 SWH 00 SDI 00 Other 32.36 Page 4 XQ STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION ¥ WAGE AND HOUR RECORD DATE 02/26/13 (c) EXCEPTIONS EXCEPTION (CRAEFT} EXPLANATION I, Lisa S. Goodson President (Name of signatory party) (Title) do hereby state: (1) That | pay or supervise the payment of the persons amplayed by Goodson Contrators, Inc. on the Rehabilitate Runway (Contractor or Subcontractor) (Building or work) that during the payroll period commencing on the 18 day of Feb-13 and ending the 24 day of Feb-13 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 REMARKS: Goodson Contrators, inc, from the full weekly (Contractor or Subcontractor} wages eamed by any person and that no deductions have been made either directly or indirectly from the full wages eamed 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. 276c), and described below: FICA, FEDERAL WITHHOLDING, MEDICARE No Work “ NAME AND TITLE SIGNATURE fi (2) That any payrotis otherwise under thls contract required fo be submitted for the above Lisa S. Goodson, President Ne fA an period are correct and complete; that the wage rates for laborers or mechanics contained therein are not jet ALA . = / Fe less than the applicable wage rates contained In any wage determination Incorporated into the contract; THE WILLFUL FALSIFICATION4OF ANY OF THE ABOVE that the classifications set forth therein for each laborer or mechanic conform with the work he performed. STATEMENTS MAY SUBJECT THE CONTRACTOR OR (3) That any apprentices employed in the above period are duly registered in a bona fide SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 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 inthe above referenced payroll, payments of fringe benefits as fisted 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 Each laborer or mechanic listed in the above referenced payrol! 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: x THE UNITED STATES CODE. 700-010-69 Construction O10 700-010-69 Construction 01/10 a STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION ‘ WAGE AND HOUR RECORD DATE 03/04/13 (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION I, Lisa S. Goodson President (Name of signatory party) (Titley do hereby state: (1) That | pay or supervise the payment of the persons employed by Goodson Contrators, Inc. on the Rehabilitate Runway (Contractor or Subcontractor) (Building or work) that during the payroll period commencing on the 25 day of Feb-13 and ending the 3 day of Mar-13 all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of saict REMARKS: Goodson Contrators, inc. from the full weekly {Contractor or Subcontractor) wages eamed by any person and that no deductions have been made either directly or indirectly from the full wages eamed 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. 2760), and described below: FIGA, FEDERAL WITHHOLDING, MEDICARE No Work NAME AND TITLE SIGNATURE di ; (2) That any payrolls otherwise under this contract required to be submitted for the above Lisa S. Goodson, President SAS. y ViT Le VA period are correct ard complete; that the wage rates for laborers or mechanics contained therein are not ; A : Ld ts ee Jess than the applicable wage rates contained in any wage determination incorporated into the contract; THE WILLFUL FALSIFICATION OF-ANY OF THE ABOVE that the classifications set forth therein for each laborer or mechanic conform with the work he performed. STATEMENTS MAY SUBJECT THE CONTRACTOR OR (3) That any apprentices employed in the above period are duly registered in a bona fide SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of SECTION 1001 GF TITLE 18 AND SECTION 231 OF TITLE 31 OF Apprenticeship and Training, United States Department of Labor, or if no such recagnized 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 fk____—ach laborer or mechanic fisted 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: THE UNITED STATES CODE. x STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION WAGE AND HOUR RECORD DATE 03/12/43 (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION 1, Lisa S. Goodson President (Name of signatory party) (Title) do hereby state: (1) That | pay or supervise the payment of the persons employed by Goodson Contrators, Inc. on the Rehabilitate Runway (Contractor or Subcontractor) (Building or work) that during the payroll period commencing on the 4 day of Mar-13 and ending the 10 day of Mar-13 all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said REMARKS: Goodson Contrators, Inc. from the full weekly (Gontractor or Subcontractor) wages eamed 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 Stal. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Cp al FICA, FEDERAL WITHHOLDING, MEDICARE No Work 4 NAME AND TITLE SIGNATURE (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 or mechanics contained therein are not less 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 apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Deparment of Labor, or if no such recognized agency exists ina 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 Sectlon 4(c} 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(c) below: j sa. Goodson, President [> NM A Lisa S. Goodson, President >< ( a ee THE WILLEUL 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. 700-010-689 Construction 01/10 PAYROLL (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Rev. Dec, 2008 1 « STATEMENT OF COMPLIANCE (CERTIFICATION UNDER PENALTY OF PERJURY) U.S. Department of Labor Wage and Hour Division ental Hour Division Date 02/22/2043 at |, ,, do certify under penalty of perjury: 1} That all of the information in thts report is true and correct. 2) That | pay or supervise the payment of the persons employed by Ryles Grassing LLC on the Destin Airport job, that during