2016-08 Cook and Solis Construction Certified Payroll136.96
2497.20
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 39.8940.00
0.00
22.54
0.000.00
280.75 113.90 0.00
0.00
1451.11 1046.09
626226679
0.00
919.50
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2497.20
28448
Other Deduction Detail: Other: 901.60, SDI: 17.90
Male
136.79
2513.44
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
8.00
00000
0 000 0 47.108.00
0.00
27.71
0.000.00
131.42 46.54 0.00
0.00
1281.59 1231.85
613058757
0.00
966.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
598.48
28449
Other Deduction Detail: Other: 948.96, SDI: 17.88
Male
136.79
2513.44
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
0
00000
0 08.00 8.00 0 36.3416.00
0.00
22.54
0.000.00
131.42 46.54 0.00
0.00
1281.59 1231.85
613058757
0.00
966.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
28449
Other Deduction Detail: Other: 948.96, SDI: 17.88
Male
136.79
2513.44
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 4
0
Andres Franco
S
D 0
0
00000
8.00 8.0000 0 37.8916.00
0.00
22.54
0.000.00
131.42 46.54 0.00
0.00
1281.59 1231.85
613058757
0.00
966.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
966.88
28449
Other Deduction Detail: Other: 948.96, SDI: 17.88
Male
94.19
1692.40
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 4
0
Luz Velasquez
S
D 0
0
00000
8.00 000 0 37.898.00
0.00
22.54
0.000.00
45.22 8.47 0.00
0.00
795.87 896.53
625017899
0.00
647.99
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
440011
Other Deduction Detail: Other: 635.68, SDI: 12.31
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
1.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/26/2019 2016-08/2016-08
20 21 22 23 24 25 26
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
1.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/26/2019 2016-08/2016-08
20 21 22 23 24 25 26
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
94.19
1692.40
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
8.00
00000
0 8.0000 0 47.1016.00
0.00
27.71
0.000.00
45.22 8.47 0.00
0.00
795.87 896.53
625017899
0.00
647.99
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
440011
Other Deduction Detail: Other: 635.68, SDI: 12.31
Male
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #1, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
20th
Payroll Supervisor
November 4th, 2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019October26th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
136.97
2497.20
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 39.8940.00
0.00
22.54
0.000.00
280.75 113.90 0.00
0.00
1451.13 1046.07
626226679
0.00
919.51
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2497.20
28453
Other Deduction Detail: Other: 901.60, SDI: 17.91
Male
152.47
2755.52
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
8.00
00000
0 8.0000 0 36.3416.00
0.00
22.54
0.000.00
156.02 62.65 0.00
0.00
1434.75 1320.77
613058757
0.00
1063.61
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
28454
Other Deduction Detail: Other: 1043.68, SDI: 19.93
Male
152.47
2755.52
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
0
00000
8.00 08.00 8.00 0 47.8524.00
0.00
27.71
0.000.00
156.02 62.65 0.00
0.00
1434.75 1320.77
613058757
0.00
1063.61
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1813.44
28454
Other Deduction Detail: Other: 1043.68, SDI: 19.93
Male
100.88
1884.16
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
8.00
00000
8.00 8.0008.00 0 36.3432.00
0.00
22.54
0.000.00
194.40 68.15 0.00
0.00
1097.90 786.26
604921080
0.00
734.47
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1884.16
450011
Other Deduction Detail: Other: 721.28, SDI: 13.19
Male
36.37
795.60
Mecca, CA 92254
P O Box 1317
Fringe Detail: Annuity: $12.00/$0.50, Health&Safety Fund: $125.52/$5.23, Pension: $40.32/$1.68, Training Fund: $16.56/$0.69, Vacation: $81.84/$3.41, Other: $14.64/$0.61
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
8.00
00000
8.00 8.0000 0 21.0324.00
0.00
0.00
0.000.00
38.50 6.71 8.50
0.00
386.82 408.78
621742124
0.00
296.74
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
504.72
Apprentice Level 2 335
Other Deduction Detail: SDI: 5.86, Fringe Ded: 290.88
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
2.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/02/2019 2016-08/2016-08
27 28 29 30 31 1 2
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
144.63
2634.48
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
8.00
00000
0 8.0000 0 47.8516.00
0.00
27.71
0.000.00
124.34 48.62 0.00
0.00
1332.82 1301.66
625017899
0.00
1015.23
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1208.96
450012
Other Deduction Detail: Other: 996.32, SDI: 18.91
Male
144.63
2634.48
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 3
0
Luz Velasquez
S
D 0
0
00000
8.00 008.00 0 36.3416.00
0.00
22.54
0.000.00
124.34 48.62 0.00
0.00
1332.82 1301.66
625017899
0.00
1015.23
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
450012
Other Deduction Detail: Other: 996.32, SDI: 18.91
Male
144.63
2634.48
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 4
0
Luz Velasquez
S
D 0
0
00000
0 08.00 0 0 37.898.00
0.00
22.54
0.000.00
124.34 48.62 0.00
0.00
1332.82 1301.66
625017899
0.00
1015.23
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
450012
Other Deduction Detail: Other: 996.32, SDI: 18.91
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
2.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/02/2019 2016-08/2016-08
27 28 29 30 31 1 2
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #2, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Revised employee payroll for additional deductions
Cook and Solis Construction (a sub of Urban Habitat)
27th
Payroll Supervisor
November 14th,
2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019October2nd
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Fringe Ded, Other, SDI
136.96
2497.20
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 39.8940.00
0.00
22.54
0.000.00
280.75 113.90 0.00
0.00
1451.11 1046.09
626226679
0.00
919.50
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2497.20
28459
Other Deduction Detail: Other: 901.60, SDI: 17.90
Male
161.25
2864.96
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
8.00
00000
0 000 0 36.348.00
0.00
22.54
0.000.00
169.81 72.75 0.00
0.00
1491.93 1373.03
613058757
0.00
1088.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
471.04
28460
Other Deduction Detail: Other: 1067.04, SDI: 21.08
Male
161.25
2864.96
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
0
00000
8.00 8.008.00 8.00 0 47.1032.00
0.00
27.71
0.000.00
169.81 72.75 0.00
0.00
1491.93 1373.03
613058757
0.00
1088.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2393.92
28460
Other Deduction Detail: Other: 1067.04, SDI: 21.08
Male
113.49
2119.68
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
8.00
00000
8.00 4.008.00 8.00 0 36.3436.00
0.00
22.54
0.000.00
230.66 85.02 0.00
0.00
1255.45 864.23
604921080
0.00
826.28
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2119.68
460011
Other Deduction Detail: Other: 811.44, SDI: 14.84
Male
143.67
2610.08
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 3
0
Luz Velasquez
S
D 0
0
00000
8.00 08.00 8.00 0 36.3424.00
0.00
22.54
0.000.00
122.85 47.53 0.00
0.00
1317.15 1292.93
625017899
0.00
1003.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
460012
Other Deduction Detail: Other: 984.32, SDI: 18.78
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
3.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/09/2019 2016-08/2016-08
3 4 5 6 7 8 9
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
3.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/09/2019 2016-08/2016-08
3 4 5 6 7 8 9
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
143.67
2610.08
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
8.00
00000
0 8.0000 0 47.1016.00
0.00
27.71
0.000.00
122.85 47.53 0.00
0.00
1317.15 1292.93
625017899
0.00
1003.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
460012
Other Deduction Detail: Other: 984.32, SDI: 18.78
Male
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #3, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
3rd
Payroll Supervisor
November 22nd,
2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019November9th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
114.71
2091.43
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.0008.00 0 39.8932.00
0.00
22.54
0.000.00
216.40 84.14 0.00
0.00
1185.36 906.07
626226679
0.00
770.11
1)
2)
3)O 0 0 0 0 0 1.00 0 1.00 59.84 22.54
2080.14
28464
Other Deduction Detail: Other: 755.11, SDI: 15.00
Male
120.82
2183.21
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
0
00000
8.00 008.00 0 47.1016.00
0.00
27.71
0.000.00
106.39 32.77 0.00
0.00
1096.68 1086.53
613058757
0.00
836.70
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
28465
Other Deduction Detail: Other: 820.91, SDI: 15.79
Male
120.82
2183.21
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
8.00
00000
0 8.0000 0 36.3416.00
0.00
22.54
0.000.00
106.39 32.77 0.00
0.00
1096.68 1086.53
613058757
0.00
836.70
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
980.60
28465
Other Deduction Detail: Other: 820.91, SDI: 15.79
Male
103.25
1928.33
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
8.00
00000
8.00 8.0008.00 0 36.3432.00
0.00
22.54
0.000.00
183.43 68.81 0.00
0.00
1107.18 821.15
617522695
0.00
751.69
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
1922.68
470007
Other Deduction Detail: Other: 738.19, SDI: 13.50
Male
103.25
1928.33
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
8.00
00000
8.00 8.0008.00 0 36.3432.00
0.00
22.54
0.000.00
201.20 71.31 0.00
0.00
1127.44 800.89
604921080
0.00
751.68
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
1922.68
470011
Other Deduction Detail: Other: 738.19, SDI: 13.49
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
4.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/16/2019 2016-08/2016-08
10 11 12 13 14 15 16
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
103.25
1928.33
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
8.00
00000
8.00 8.0008.00 0 36.3432.00
0.00
22.54
0.000.00
147.89 63.81 0.00
0.00
1066.64 861.69
554618002
0.00
751.69
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
1922.68
28463
Other Deduction Detail: Other: 738.19, SDI: 13.50
Male
60.83
1085.84
Mecca, CA 92254
P O Box 1317
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
8.00
00000
8.00 8.0008.00 0 21.0332.00
0.00
12.12
0.000.00
63.53 17.99 0.00
0.00
552.67 533.17
621742124
0.00
410.32
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 31.54 12.12
1082.63
Apprentice Level 2 28466
Other Deduction Detail: Other: 402.36, SDI: 7.96
Male
121.65
2194.78
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
8.00
00000
0 8.0000 0 47.1016.00
0.00
27.71
0.000.00
88.29 28.48 0.00
0.00
1078.73 1116.05
625017899
0.00
840.31
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 70.65 27.71
1246.14
470012
Other Deduction Detail: Other: 824.41, SDI: 15.90
Male
121.65
2194.78
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 3
0
Luz Velasquez
S
D 0
0
00000
8.00 008.00 0 36.3416.00
0.00
22.54
0.000.00
88.29 28.48 0.00
0.00
1078.73 1116.05
625017899
0.00
840.31
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
470012
Other Deduction Detail: Other: 824.41, SDI: 15.90
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
4.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/16/2019 2016-08/2016-08
10 11 12 13 14 15 16
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Revised Payroll #4.1,
Contractor License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
10th
Payroll Supervisor
December 2nd, 2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019November16th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
123.65
2221.76
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.0008.00 0 39.8932.00
0.00
22.54
0.000.00
242.11 82.24 0.00
0.00
1185.44 1036.32
626226679
0.00
737.44
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1997.76
28470
Other Deduction Detail: Other: 721.28, SDI: 16.16
Male
152.47
2737.52
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
8.00
00000
0 08.00 8.00 0 47.1024.00
0.00
27.71
0.000.00
156.02 62.65 0.00
0.00
1416.75 1320.77
613058757
0.00
1045.61
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1795.44
28471
Other Deduction Detail: Other: 1025.68, SDI: 19.93
Male
152.47
2737.52
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
0
00000
8.00 8.0000 0 36.3416.00
0.00
22.54
0.000.00
156.02 62.65 0.00
0.00
1416.75 1320.77
613058757
0.00
1045.61
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
28471
Other Deduction Detail: Other: 1025.68, SDI: 19.93
Male
125.47
2338.18
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
7.50
00000
8.00 08.00 8.00 0 36.3431.50
0.00
22.54
0.000.00
247.36 98.53 0.00
0.00
1378.11 960.07
617522695
0.00
906.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1854.72
480007
Other Deduction Detail: Other: 890.35, SDI: 16.40
Male
125.47
2338.18
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 4
0
Sergio Lopez Jr.
S
D 0
0
00000
0 8.0000 0 37.898.00
0.00
22.54
0.000.00
247.36 98.53 0.00
0.00
1378.11 960.07
617522695
0.00
906.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
480007
Other Deduction Detail: Other: 890.35, SDI: 16.40
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
5.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
124.53
2325.78
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
7.50
00000
8.00 8.008.00 8.00 0 36.3439.50
0.00
22.54
0.000.00
262.40 99.77 0.00
0.00
1393.33 932.45
604921080
0.00
906.63
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2325.76
480011
Other Deduction Detail: Other: 890.35, SDI: 16.28
Male
125.47
2338.18
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
7.50
00000
0 8.008.00 8.00 0 36.3431.50
0.00
22.54
0.000.00
211.82 93.53 0.00
0.00
1337.57 1000.61
554618002
0.00
906.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1854.72
28469
Other Deduction Detail: Other: 890.35, SDI: 16.40
Male
125.47
2338.18
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 4
0
Ricardo Lopez
S
D 0
0
00000
8.00 000 0 37.898.00
0.00
22.54
0.000.00
211.82 93.53 0.00
0.00
1337.57 1000.61
554618002
0.00
906.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
28469
Other Deduction Detail: Other: 890.35, SDI: 16.40
Male
73.85
1309.45
Mecca, CA 92254
P O Box 1317
Fringe Detail: Other: $24.10/$0.61, Health&Safety Fund: $206.585/$5.23, Pension: $66.36/$1.68, Training Fund: $27.26/$0.69, Vacation: $134.695/$3.41, Annuity: $19.75/$0.50
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
7.50
00000
8.00 8.008.00 8.00 0 21.0339.50
0.00
0.00
0.000.00
83.96 29.83 0.00
0.00
676.05 633.40
621742124
0.00
488.41
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
830.68
Apprentice Level 2 28472
Other Deduction Detail: Other: 478.76, SDI: 9.65
Male
143.68
2610.08
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
0
00000
8.00 8.0000 0 47.1016.00
0.00
27.71
0.000.00
122.85 47.53 0.00
0.00
1317.16 1292.92
625017899
0.00
1003.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
480012
Other Deduction Detail: Other: 984.32, SDI: 18.78
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
5.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
5.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
143.68
2610.08
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 3
0
Luz Velasquez
S
D 0
8.00
00000
0 08.00 8.00 0 36.3424.00
0.00
22.54
0.000.00
122.85 47.53 0.00
0.00
1317.16 1292.92
625017899
0.00
1003.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
480012
Other Deduction Detail: Other: 984.32, SDI: 18.78
Male
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #5, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
17th
Payroll Supervisor
December 6th, 2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019November23rd
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
82.19
1498.32
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
8.00 08.00 8.00 0 39.8924.00
0.00
22.54
0.000.00
122.85 41.90 0.00
0.00
798.64 699.68
626226679
0.00
551.70
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1498.32
28476
Other Deduction Detail: Other: 540.96, SDI: 10.74
Male
93.25
1668.00
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
0
00000
0 08.00 8.00 0 47.1016.00
0.00
27.71
0.000.00
63.11 12.92 0.00
0.00
805.15 862.85
613058757
0.00
635.87
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
28477
Other Deduction Detail: Other: 623.68, SDI: 12.19
Male
93.25
1668.00
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
0
00000
8.00 000 0 36.348.00
0.00
22.54
0.000.00
63.11 12.92 0.00
0.00
805.15 862.85
613058757
0.00
635.87
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
471.04
28477
Other Deduction Detail: Other: 623.68, SDI: 12.19
Male
75.66
1413.12
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
0
00000
8.00 08.00 8.00 0 36.3424.00
0.00
22.54
0.000.00
104.10 34.41 0.00
0.00
765.02 648.10
617522695
0.00
550.85
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
490007
Other Deduction Detail: Other: 540.96, SDI: 9.89
Male
75.66
1413.12
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
0
00000
8.00 08.00 8.00 0 36.3424.00
0.00
22.54
0.000.00
121.87 36.91 0.00
0.00
785.29 627.83
604921080
0.00
550.85
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
490011
Other Deduction Detail: Other: 540.96, SDI: 9.89
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/30/2019 2016-08/2016-08
24 25 26 27 28 29 30
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
75.67
1413.12
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
0
00000
8.00 08.00 8.00 0 36.3424.00
0.00
22.54
0.000.00
77.10 29.41 0.00
0.00
733.03 680.09
554618002
0.00
550.85
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
28475
Other Deduction Detail: Other: 540.96, SDI: 9.89
Male
44.88
795.60
Mecca, CA 92254
P O Box 1317
Fringe Detail: Other: $14.64/$0.61, Health&Safety Fund: $125.52/$5.23, Pension: $40.32/$1.68, Training Fund: $16.56/$0.69, Vacation: $81.84/$3.41, Annuity: $12.00/$0.50
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
0
00000
8.00 08.00 8.00 0 21.0324.00
0.00
0.00
0.000.00
38.50 6.71 0.00
0.00
386.84 408.76
621742124
0.00
296.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
504.72
Apprentice Level 2 28478
Other Deduction Detail: Other: 290.88, SDI: 5.87
Male
84.45
1540.56
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
0
00000
8.00 000 0 47.108.00
0.00
27.71
0.000.00
31.17 2.87 0.00
0.00
711.85 828.71
625017899
0.00
593.36
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
598.48
490012
Other Deduction Detail: Other: 582.32, SDI: 11.04
Male
84.45
1540.56
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 3
0
Luz Velasquez
S
D 0
0
00000
0 08.00 8.00 0 36.3416.00
0.00
22.54
0.000.00
31.17 2.87 0.00
0.00
711.85 828.71
625017899
0.00
593.36
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
490012
Other Deduction Detail: Other: 582.32, SDI: 11.04
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/30/2019 2016-08/2016-08
24 25 26 27 28 29 30
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #6, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
24th
Payroll Supervisor
December 6th, 2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019November30th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
27.58
499.84
Mecca, CA 92254
91150 Las Serenas
Fringe Detail: Other: $9.76/$0.61, Health&Safety Fund: $83.68/$5.23, Pension: $26.88/$1.68, Training Fund: $11.04/$0.69, Vacation: $54.56/$3.41, Annuity: $8.00/$0.50
0
0Laborer/Group 1
0
Jose Beltran
S
D 0
8.00
00000
0 8.0000 0 19.1216.00
0.00
0.00
0.000.00
0.00 0.00 0.00
0.00
225.10 274.74
624363037
0.00
197.52
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
305.92
Apprentice Level 1 28482
Other Deduction Detail: Other: 193.92, SDI: 3.60
Male
136.96
2497.20
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 39.8940.00
0.00
22.54
0.000.00
280.75 113.90 0.00
0.00
1451.12 1046.08
626226679
0.00
919.51
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2497.20
28483
Other Deduction Detail: Other: 901.60, SDI: 17.91
Male
135.45
2438.28
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Laborer: Group 3
0
Andres Franco
S
D 0
8.00
00000
0 8.0000 0 36.3416.00
0.00
22.54
0.000.00
129.34 45.40 0.00
0.00
1242.74 1195.54
613058757
0.00
932.55
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
942.08
28484
Other Deduction Detail: Other: 914.84, SDI: 17.71
Male
135.45
2438.28
Valley Center, CA 92082
12275 Sierra Rojo Rd
0
0Operating Engineer:
Group 1
0
Andres Franco
S
D 0
0
00000
4.00 08.00 8.00 0 47.1020.00
0.00
27.71
0.000.00
129.34 45.40 0.00
0.00
1242.74 1195.54
613058757
0.00
932.55
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1496.20
28484
Other Deduction Detail: Other: 914.84, SDI: 17.71
Male
101.83
1896.56
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
0
00000
8.00 8.0008.00 0 36.3424.00
0.00
22.54
0.000.00
179.36 66.92 0.00
0.00
1082.70 813.86
617522695
0.00
734.59
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
500007
Other Deduction Detail: Other: 721.28, SDI: 13.31
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
7.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
101.83
1896.56
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 4
0
Sergio Lopez Jr.
S
D 0
0
00000
0 08.00 0 0 37.898.00
0.00
22.54
0.000.00
179.36 66.92 0.00
0.00
1082.70 813.86
617522695
0.00
734.59
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
500007
Other Deduction Detail: Other: 721.28, SDI: 13.31
Male
64.00
1190.00
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 4
0
Galileo Lopez
S
D 0
0
00000
0 08.00 0 0 37.898.00
0.00
22.54
0.000.00
88.34 25.73 0.00
0.00
637.24 552.76
604921080
0.00
459.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
500011
Other Deduction Detail: Other: 450.80, SDI: 8.37
Male
64.00
1190.00
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
0
00000
4.00 008.00 0 36.3412.00
0.00
22.54
0.000.00
88.34 25.73 0.00
0.00
637.24 552.76
604921080
0.00
459.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
706.56
500011
Other Deduction Detail: Other: 450.80, SDI: 8.37
Male
101.83
1896.56
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
8.00
00000
8.00 8.0000 0 36.3424.00
0.00
22.54
0.000.00
143.82 61.92 0.00
0.00
1042.16 854.40
554618002
0.00
734.59
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1413.12
28481
Other Deduction Detail: Other: 721.28, SDI: 13.31
Male
101.83
1896.56
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 4
0
Ricardo Lopez
S
D 0
0
00000
0 08.00 0 0 37.898.00
0.00
22.54
0.000.00
143.82 61.92 0.00
0.00
1042.16 854.40
554618002
0.00
734.59
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
483.44
28481
Other Deduction Detail: Other: 721.28, SDI: 13.31
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
7.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
67.31
1193.40
Mecca, CA 92254
P O Box 1317
Fringe Detail: Other: $21.96/$0.61, Health&Safety Fund: $188.28/$5.23, Pension: $60.48/$1.68, Training Fund: $24.84/$0.69, Vacation: $122.76/$3.41, Annuity: $18.00/$0.50
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
8.00
00000
4.00 8.008.00 8.00 0 21.0336.00
0.00
0.00
0.000.00
73.69 23.57 0.00
0.00
609.69 583.71
621742124
0.00
445.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
757.08
Apprentice Level 2 28485
Other Deduction Detail: Other: 436.32, SDI: 8.80
Male
120.35
2163.84
DesertHotSprings, CA 92240
66617
0
0Operating Engineer:
Group 1
0
Luz Velasquez
S
D 0
8.00
00000
0 8.0000 0 47.1016.00
0.00
27.71
0.000.00
86.27 27.36 0.00
0.00
1053.71 1110.13
625017899
0.00
819.73
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
500012
Other Deduction Detail: Other: 804.00, SDI: 15.73
Male
120.35
2163.84
DesertHotSprings, CA 92240
66617
0
0Laborer: Group 4
0
Luz Velasquez
S
D 0
0
00000
0 08.00 8.00 0 37.8916.00
0.00
22.54
0.000.00
86.27 27.36 0.00
0.00
1053.71 1110.13
625017899
0.00
819.73
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
966.88
500012
Other Deduction Detail: Other: 804.00, SDI: 15.73
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
7.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #7, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
1st
Payroll Supervisor
December 16th,
2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019December7th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
74.78
1326.00
Mecca, CA 92254
91150 Las Serenas
Fringe Detail: Other: $24.40/$0.61, Health&Safety Fund: $209.20/$5.23, Pension: $67.20/$1.68, Training Fund: $27.60/$0.69, Vacation: $136.40/$3.41, Annuity: $20.00/$0.50
0
0Laborer/Group 1
0
Jose Beltran
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 21.0340.00
0.00
0.00
0.000.00
34.69 2.31 0.00
0.00
606.36 719.64
624363037
0.00
494.58
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
841.20
Apprentice Level 2 28489
Other Deduction Detail: Other: 484.80, SDI: 9.78
Male
150.19
2695.28
Indio, CA 92201
45481 Park St #9
0
0Operating Engineer:
Group 1
0
Alfredo Federico
S
D 0
8.00
00000
0 8.0000 0 47.1016.00
0.00
27.71
0.000.00
322.26 131.59 0.00
0.00
1607.99 1087.29
626226679
0.00
1003.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
28490
Other Deduction Detail: Other: 984.32, SDI: 19.63
Male
150.19
2695.28
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
8.00 08.00 8.00 0 39.8924.00
0.00
22.54
0.000.00
322.26 131.59 0.00
0.00
1607.99 1087.29
626226679
0.00
1003.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1498.32
28490
Other Deduction Detail: Other: 984.32, SDI: 19.63
Male
154.83
2781.69
Coachella,, CA 92236
84531 Via Durango
0
0Operating Engineer:
Group 1
0
Sergio Lopez Jr.
S
D 0
0
00000
8.00 08.00 8.00 0 47.1024.00
0.00
27.71
0.000.00
336.79 137.80 0.00
0.00
1692.25 1089.44
617522695
0.00
1062.83
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1795.44
510007
Other Deduction Detail: Other: 1042.59, SDI: 20.24
Male
154.83
2781.69
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
8.00
00000
0 8.0000 0 36.3416.00
0.00
22.54
0.000.00
336.79 137.80 0.00
0.00
1692.25 1089.44
617522695
0.00
1062.83
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
980.60
510007
Other Deduction Detail: Other: 1042.59, SDI: 20.24
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
8.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
128.47
2399.37
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 36.3440.00
0.00
22.54
0.000.00
220.42 97.54 0.00
0.00
1381.73 1017.64
554618002
0.00
935.30
1)
2)
3)O 0 0 0 0 0 0.50 0 0.50 54.51 22.54
2393.72
28488
Other Deduction Detail: Other: 918.51, SDI: 16.79
Male
74.78
1326.00
Mecca, CA 92254
P O Box 1317
Fringe Detail: Other: $24.40/$0.61, Health&Safety Fund: $209.20/$5.23, Pension: $67.20/$1.68, Training Fund: $27.60/$0.69, Vacation: $136.40/$3.41, Annuity: $20.00/$0.50
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 21.0340.00
0.00
0.00
0.000.00
85.42 30.91 0.00
0.00
685.68 640.32
621742124
0.00
494.57
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
841.20
Apprentice Level 2 28491
Other Deduction Detail: Other: 484.80, SDI: 9.77
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
8.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #8, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
8th
Payroll Supervisor
December 18th,
2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019December14th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
44.88
795.60
Mecca, CA 92254
91150 Las Serenas
Fringe Detail: Other: $14.64/$0.61, Health&Safety Fund: $125.52/$5.23, Pension: $40.32/$1.68, Training Fund: $16.56/$0.69, Vacation: $81.84/$3.41, Annuity: $12.00/$0.50
0
0Laborer/Group 1
0
Jose Beltran
S
D 0
0
00000
8.00 08.00 8.00 0 21.0324.00
0.00
0.00
0.000.00
0.00 0.00 0.00
0.00
341.63 453.97
624363037
0.00
296.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
504.72
Apprentice Level 2 28494
Other Deduction Detail: Other: 290.88, SDI: 5.87
Male
152.77
2742.11
Indio, CA 92201
45481 Park St #9
0
0Operating Engineer:
Group 1
0
Alfredo Federico
S
D 0
8.00
00000
0 008.00 0 47.1016.00
0.00
27.71
0.000.00
330.31 135.03 0.00
0.00
1639.31 1102.80
626226679
0.00
1021.20
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1196.96
28495
Other Deduction Detail: Other: 1001.23, SDI: 19.97
Male
152.77
2742.11
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
8.00 8.008.00 0 0 39.8924.00
0.00
22.54
0.000.00
330.31 135.03 0.00
0.00
1639.31 1102.80
626226679
0.00
1021.20
1)
2)
3)O 0 0 0 0.50 0 0 0 0.50 59.84 22.54
1539.51
28495
Other Deduction Detail: Other: 1001.23, SDI: 19.97
Male
154.84
2781.69
Coachella,, CA 92236
84531 Via Durango
0
0Operating Engineer:
Group 1
0
Sergio Lopez Jr.
S
D 0
0
00000
0 8.008.00 8.00 0 47.1024.00
0.00
27.71
0.000.00
336.80 137.80 0.00
0.00
1692.27 1089.42
617522695
0.00
1062.83
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1795.44
520007
Other Deduction Detail: Other: 1042.59, SDI: 20.24
Male
154.84
2781.69
Coachella,, CA 92236
84531 Via Durango
0
0Laborer: Group 3
0
Sergio Lopez Jr.
S
D 0
8.00
00000
8.00 000 0 36.3416.00
0.00
22.54
0.000.00
336.80 137.80 0.00
0.00
1692.27 1089.42
617522695
0.00
1062.83
1)
2)
3)O 0 0 0 0.50 0 0 0 0.50 54.51 22.54
980.60
520007
Other Deduction Detail: Other: 1042.59, SDI: 20.24
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
9.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/21/2019 2016-08/2016-08
15 16 17 18 19 20 21
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
128.47
2399.37
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 36.3440.00
0.00
22.54
0.000.00
220.42 97.54 0.00
0.00
1381.74 1017.63
554618002
0.00
935.31
1)
2)
3)O 0 0 0 0.50 0 0 0 0.50 54.51 22.54
2393.72
28493
Other Deduction Detail: Other: 918.51, SDI: 16.80
Male
44.88
795.60
Mecca, CA 92254
P O Box 1317
Fringe Detail: Other: $14.64/$0.61, Health&Safety Fund: $125.52/$5.23, Pension: $40.32/$1.68, Training Fund: $16.56/$0.69, Vacation: $81.84/$3.41, Annuity: $12.00/$0.50
0
0Laborer/Group 1
0
Dagoberto Manzo
S
D 0
0
00000
8.00 08.00 8.00 0 21.0324.00
0.00
0.00
0.000.00
38.50 6.71 0.00
0.00
386.84 408.76
621742124
0.00
296.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
504.72
Apprentice Level 2 28496
Other Deduction Detail: Other: 290.88, SDI: 5.87
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
9.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/21/2019 2016-08/2016-08
15 16 17 18 19 20 21
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #9, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
15th
Payroll Supervisor
December 26th,
2019
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019December21st
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
51.13
910.63
Indio, CA 92201
45481 Park St #9
0
0Operating Engineer:
Group 1
0
Alfredo Federico
S
D 0
8.00
00000
0 000 0 47.108.00
0.00
27.71
0.000.00
58.01 12.29 0.00
0.00
462.49 448.14
626226679
0.00
341.06
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
598.48
28498
Other Deduction Detail: Other: 334.38, SDI: 6.68
Male
51.13
910.63
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
0 05.00 0 0 39.895.00
0.00
22.54
0.000.00
58.01 12.29 0.00
0.00
462.49 448.14
626226679
0.00
341.06
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
312.15
28498
Other Deduction Detail: Other: 334.38, SDI: 6.68
Male
21.26
374.05
Coachella,, CA 92236
84531 Via Durango
0
0Operating Engineer:
Group 1
0
Sergio Lopez Jr.
S
D 0
0
00000
0 05.00 0 0 47.105.00
0.00
27.71
0.000.00
12.40 0.00 0.00
0.00
174.99 199.06
617522695
0.00
141.33
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
374.05
010006
Other Deduction Detail: Other: 138.55, SDI: 2.78
Male
40.99
765.44
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
8.00
00000
0 05.00 0 0 36.3413.00
0.00
22.54
0.000.00
22.71 1.29 0.00
0.00
363.37 402.07
554618002
0.00
298.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
765.44
28497
Other Deduction Detail: Other: 293.02, SDI: 5.36
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
10.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #10, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
22nd
Payroll Supervisor
January 2nd, 2020
Cook and Solis Construction (a sub of Urban Habitat)
2019 20192019December28th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
30.81
561.87
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
2.00
00000
0 07.00 0 0 39.899.00
0.00
22.54
0.000.00
25.86 2.50 0.00
0.00
266.06 295.81
626226679
0.00
206.89
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
561.87
28500
Other Deduction Detail: Other: 202.86, SDI: 4.03
Male
22.06
412.16
Coachella, CA 92236
1465 2nd Street
0
0Laborer: Group 3
0
Ricardo Lopez
S
D 0
0
00000
0 07.00 0 0 36.347.00
0.00
22.54
0.000.00
0.00 0.00 0.00
0.00
182.72 229.44
554618002
0.00
160.66
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
412.16
28499
Other Deduction Detail: Other: 157.78, SDI: 2.88
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/04/2020 2016-08/2016-08
29 30 31 1 2 3 4
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #11, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
29th
Payroll Supervisor
January 9th, 2020
Cook and Solis Construction (a sub of Urban Habitat)
2019 20202020December4th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
47.83
861.11
Indio, CA 92201
45481 Park St #9
0
0Operating Engineer:
Group 1
0
Alfredo Federico
S
D 0
0
00000
0 004.00 0 47.104.00
0.00
27.71
0.000.00
52.52 10.39 0.00
0.00
430.69 430.42
626226679
0.00
319.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
299.24
28503
Other Deduction Detail: Other: 313.70, SDI: 6.25
Male
47.83
861.11
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
5.00 004.00 0 39.899.00
0.00
22.54
0.000.00
52.52 10.39 0.00
0.00
430.69 430.42
626226679
0.00
319.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
561.87
28503
Other Deduction Detail: Other: 313.70, SDI: 6.25
Male
40.99
765.44
Coachella, CA 92236
84521 Via Durango
0
0Laborer: Group 3
0
Galileo Lopez
S
D 0
0
00000
5.00 008.00 0 36.3413.00
0.00
22.54
0.000.00
51.72 9.04 0.00
0.00
400.13 365.31
604921080
0.00
298.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
765.44
030009
Other Deduction Detail: Other: 293.02, SDI: 5.36
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
12.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/11/2020 2016-08/2016-08
5 6 7 8 9 10 11
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #12, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
5th
Payroll Supervisor
January 14th, 2020
Cook and Solis Construction (a sub of Urban Habitat)
2020 20202020January11th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI
50.65
792.72
Indio, CA 92201
45481 Park St #9
0
0Laborer: Group 4
0
Alfredo Federico
S
D 0
0
00000
0 04.00 0 0 39.894.00
0.00
22.54
0.000.00
56.96 13.04 0.00
0.00
217.43 575.29
626226679
0.00
96.78
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
249.72
28505
Other Deduction Detail: Other: 90.16, SDI: 6.62
Male
2) Local Tax 2
* Other Deductions - 1) Local Tax 1
3) Other Deductions
TOTAL
DEDUCTIONS
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
OR SUBCONTRACTORNAME OF CONTRACTOR ADDRESS
PROJECT AND LOCATION PROJECT OR CONTRACT NO.FOR WEEK ENDINGPAYROLL NO.
(1)(2)(3)
DEDUCTIONS
(5)(6)(7)(8)(9)(4) DAY AND DATE
Identification Number
NAME, ADDRESS, AND
OF EMPLOYEE
WORK
CLASSIFICATION
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX SWH OTHER*
NET
WAGES
PAID
FOR WEEK/NO. OF WITHHOLDING EXEMPTIONSST, OT or DTCook and Solis Construction
PO Box 310491
Escondido, CA 92030
13.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/18/2020 2016-08/2016-08
12 13 14 15 16 17 18
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.
§§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee
during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,
accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.
DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #13, Contractor
License # 462446, Workers Compensation Policy # UB-8K111810-19
Cook and Solis Construction (a sub of Urban Habitat)
12th
Payroll Supervisor
January 21st, 2020
Cook and Solis Construction (a sub of Urban Habitat)
2020 20202020January18th
-
* U.S. G.P.O.: 1997 519.861
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.
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
THE WILLFUL 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.
NAME AND TITLE:SIGNATURE:
REMARKS
(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.
on the
(Contractor or Subcontractor)
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 no behalf of said
from 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, California Labor
Code, Division 2, Chapter 7, Part 1 (Public Works Section 1720 thru 1861) and or described below.
(2) That the payrolls for the Public Works Project required to be submitted are true, 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 assigned to the contract, the classifications
assigned to each Laborer or Mechanic conform to the work performed.
(3) That any apprentices employed during the above period are duly registered in a bona fide program
registered with the State apprenticeship agency and that training contributions are or will be made pursuant
to California Labor Code 1777.5
(4) That:
Signed ElectronicallyKay Cook, Payroll Supervisor
Date
I,
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
a Public Works Project commencing on the
(Building or Work)
, and ending theday of ,day of ,
Kay Cook
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Other, SDI