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2016-08 Cook and Solis Construction WE 2019-11-02fficaRion undvpanafly orpe jury: "i, FLAY COOK, the undersigned, am the CORPORATE SECRETARY (position in business) with the authority to act for and on behalf of COOK AND SOLIS CONSTRUCTION. INC (name of business and/or contractor), cerStyLnder penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2019.11-02 are the Originals or true, full. and correct copies of the originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2019-11-22' tractor Name: COOKAND SOLIS CONSTRUCTION ContractorPMR: 1OW367967 License Type: CSLS T License Number 462446 ress: PO BOX 310491, ESCONDIDO, CA 92030 FEIN: 330045043 Contractor Email: KAY@COOKANOSOLIS.COM iranee Number. LIMK711810-19 riling Body: THE CITY OF LA QUINTA DIR Project TO., 30D347 Project Name. LA QUINTA SILVERROCK PARK VENUE tract With: URBAN HABITAT County: RIVERSIDE L"ation Desedption: LAQUINTASILVERROCK RESORT •oil Number: I. 0 For Week Ending: 11102J2019 MIS this a'Stater11ent of Non -Performance?' Name. Address and SOCWISeeurFtyNumberoRW«ker NtOberaf Wthho1dtn9 Dar tladacu-, COntrlWNena, and Pyyrnaw- Sun Nun Tue Wed Thu Fit Sat Totat HOM Hourly POY Rata GrossA-W Earned Feaerat Tax FICA State Tax SQi VaU MoBdey Heats a Wed. P"I"' Net Wags Palo For W� check NamW ALFREW FEDERICO 45481 PARK S7 s9 niOtO 0 Cant work taas� can 10127 10128 10129 10130 10131 11/01 W02 This Project All Projects 280.75 136.97 113.90 17.91 0.00 0.00 0.00 Naas Worked Eats Day CA 92291 e21IM678 LABORERIGRD tip S 0.00 8.00 &W 8.00 8.00 S.OD 0.00 40.00 62.43 2.497.20 2,49720 ir4iaing FOno AdrMn flues auto 9u0s S-ing, dher Total Deduct 1,048.07 28453 O D.DO 0.00 O.Od 0.00 0.00 0,00 0.00 D.00 0.00 0.00 0.00 0,00 0.00 0.00 901.60 1,451.13 D 0.00 0.00 0.00 0.00 0.00 1 0.00 0.00 0.00 0.00 E: OTHER:90160 Name,Addm--d Sas1a13xuHry Humtwrof Wodwr - NVmber of Withholding Day 13"-1-, Conbib tka and Payment Sun Mon Tac wad Thu FA Sat Lam Total Foam Hourly Pay Rate G-A d M Eanrad Fe4erN Tax FICA Sate Tax SDt V0U HoOdaq H4911h a Weu. Penion Net Wage Paid FOr weak t�edi Nrahaer 0 ANORES FRANCA 1227S SIERRA ROJO RD VALLEY CENTER 10r27 10128 10129 10130 Mal 11101 11102 This F roia« Alit Prcieas 156.02 152.47 62.65 39.86 0.00 0.01 OW Work Cl-ifiatbn Hoare Worked Eub Day CA 92082 613059757 OPERATING ENGINEER7GR0 UP 1 S 0.00 8.00 5.00 8.00 0.00 0Ab 0,00 24.00 75.56 2.75552 2.]55.52 Traan FundTpu! Admin Dues Subs Sa.+ngls 00Nr Tata1 oe4uct 1,320.77 28464 O 0.00 OAQ 0.00 0.00 D.aD 0.00 0.00 0.00 0,00 0.00 0.00 O,eo 0.00 0100 21047.36 1,434.75 D a.aD OAO 0.00 L.C.001 0.00 1 0.00 0.00 0100 0A0 OTHER:1043.58 Name, Address xhd socta9 S.-Ity NumberafW.*er Number d WIolMxtinO 1i+Y 5"-wans, conbithra-hs. Yw Paymemc Sm Man Tue Wed Thu Fri Sal Tate] Hors Hpudr Pay Rate Grass Amount Earned Federal T RG 5Wca Tax SDI VRU HOtitlay HaaM SwMf. Pantkn Nor W.'P Paid Fw Week CMdi Number MORES FRANCA 12 SIERRAROAR RD VA VALLEY 0 Date 1027 1028 10r29 10A0 tOrd1 lfflif Ni02 yapk Ciasxd4 ca8an Thrs Prajaa Alt Projects 156.02 162.47 63.65 311.16 0.00 000 0.00 Hdun Woked Ead1 pay CENTER CA 613038757 79- 0.00 0.00 0.00 8.00 8.00 0,00 16,00 Sa88 2.755.522,755.52 Trainirtp F1aW Adman Ovas 7rav1 SubsSer,ngs Othsr TOW Dtst 1,320.77 26454 0.00 O,Ip 0.00 0.00 0.00 0.00 0 00 0 PO920 0.00 0.00 C.DO 0.00 OAO 2,007.36 1,431,75 0.00 O.W 0.00 0.00 0.00 0.00 0.0D 0.00 i' OTHER0043.68 public works Certified Payroll Reporting Fun 11/22/2029 - Page I ntracter Name: COOK AND SOLIS CONSTRUCTION RrOjeet Name_ LA QUTNTA SILVERROCK PARK VENVE For Week Ending. 11102/2019 Payroll Number. 1-0 Nam., Aedrtu and S.." S-try li-borof Warker Nemba al Yfdhholding 1 Day tsedue0.ns, Ca[Itfltrudme, and Paymtaty Sun Mort Tue Wed Thu Fd $at Tout w- Hounr Pay Rate Gross A-.M Famed " T FIG S[siC Tax SDI - HalldaY H-th 6Wdl Pauimr NMgt Paid for Ylkak 1;htta Number 0 Data LFJZ 1/Fi Sra t[s 66612 This P,.!.. A9 Prq fs r12�4�3-4 144.62 48.62 66.73 0.00 0.00 0.00 4p/2> tOnB 14f29 '0130 1W31 11/01 11/02 yyark Cpsaikaatiun - HeurF Worked Each Day DE5ERTHOTSPRINGS CA, 92240 6250t7699 OPERATING ENGnvFERlOR© UP 1 S 0.00 0.00 0.00 0.00 B.pD B.Op 0.00 16.00 75.66 2.634.48 2,634.46 Training Fuaa Admin Duet T.W Sw� Ss ": 2t Other Twal 1.301.66 450012 O 0.00 OAD 0.00 0.0D D.90 0.00 D.00 DA0 O.DO 0.09 0.00 0.00 O.6D 0.00 2.91�.96 1.332.82 R 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 •TE: OTHER*95.32 Public works Certified Payroll ae;,-ing Fora 11/22/2019 - Page 3 eCI'K l•orm Application eCPR Online Confirmation Your payroll submission request has been processed. Please review the results of your submission. Should you have any questions please contact the eCPR unit at publicworks@dir.ca.gov. Contractor Name: COOK AND SOLIS CONSTRUCTION Contractor Address: PO BOX 310491 ESCONDIDO CA 92030 Awarding Body: THE CITY OF LA QUINTA Project ID: 300347 Contract With: URBAN HABITAT Week Ending Date: 2019-11-02 Payroll Number: 1 Amendment Number: 0 8 employee payroll record(s) processed Your Transaction 10 Is: 7064844 Print this Page NOR - View your submission ,, Adobe, https:flefiling.dir,ca.govleCPR/pagesdeCPROnlineFormPreFill.jsp 111