PW 26Statement of Employer Payments
Project Name:
La Quinta Landscape
Renovations @ Cactus Flower
Project No.:
10224094
Date:
January 31, 2024
Prime Contractor:
Conserve LandCare
72265 Manufacturing Rd., Thousand Palms CA 92276
Subcontractor:
Classification:
Landscape/Irrigation Laborer
Effective Date: August 1, 2023
Contribution
Rate
Trust Fund Paid To:
Health and Welfare
$8.95
Paid to employee
Pension
$11.62
Paid to employee
Vacation/Holiday
$5.02
Paid to employee
Training
$0.75
California Apprenticeship Council
P.O. Box 511283
Los Angeles, CA 90051-7838
Other
$0.50
Paid to employee
Supplemental statement must be submitted during the progress of work should a change in rate of any of the
classifications be made. I CERTIFY THAT THE FRINGE BENEFIT PAYMENTS ARE MADE TO THE APPROVED PLANS,
FUNDS OR PROGRAMS AS LISTED ABOVE.
Or: 0 I certify that I do not make payment to approved fringe benefit plans, funds or programs.
Submitted (Contractor/Subcontractor)
Conserve LandCare
By (Name and Title)
Erin Meyer
Payroll Mana er
Signature i
Statement of Employer Payments
Project Name:
La Quinta Landscape
Renovations @ Cactus Flower
Project No.:
10224094
Date:
January 31, 2024
Prime Contractor:
Conserve LandCare
72265 Manufacturing Rd., Thousand Palms CA 92276
Subcontractor:
Classification:
Landscape/Irrigation Tender
Effective Date: August 1, 2023
Contribution
Rate
Trust Fund Paid To:
Health and Welfare
$3.60
Paid to employee
Pension
$2.19
Paid to employee
Vacation/Holiday
$1.18
Paid to employee
Training
$0.00
Other
$0.00
Supplemental statement must be submitted during the progress of work should a change in rate of any of the
classifications be made. I CERTIFY THAT THE FRINGE BENEFIT PAYMENTS ARE MADE TO THE APPROVED PLANS,
FUNDS OR PROGRAMS AS LISTED ABOVE.
Or: In I certify that I do not make payment to approved fringe benefit plans, funds or programs.
Submitted (Contractor/Subcontractor)
Conserve LandCare
By (Name and Title)
Erin Meyer
Payroll Manager
Signature