2016-08 Cook and Solis Construction WE 2019-11-09% KAY 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 andfor
contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2019-11.09 are the originals or true, full, and correct
copies of the originals which depict the payroll record($) of the actual disbursements byway of cash, check, or whatever torm to the individual or individuals named_ i certily this on 2019-11-22,'
ntractor Name: COOKANO SOLIS CONSTRUCTION Contractor PWCR: 1000367967 License Type: CSU3 License Number 462446
dress: PO 90X 310491. ESCONDIDO, CA 92030 FEIN: 330045043 Contractor Email: KAY@!COOKANDSOLIS.COM
urance Number. US-46K711810.19
•arding Body: THE CITY OF LA QUiNTA DIR Project to: M347 Project Name: LA QUINTA SILVERROCK PARK VENUE
retract With: URBAN HABITAT County: RIVERSIDE Location Description: LAQUINTA SILVERROCK RESORT
yroU Number: 2- 0 For Week Ending: 11y0912019 Is this a'Statement of Non-PerformanceT
Name- Add.- -
Number or
Day
Deductl-, Cer4Vilwugna, and Payments
50-W Secuary NwaberoeWgrear
withholding
Sun Non Tut Wed Thu Fd 9a7
Total
Hovey
6rgas Amount
E-4
FMe[al
Tax
FICA
Stele
Tax
SDI
tygi
Holiday
Health
a WeB.
o"
Check
ALFREDO FEDERICO
0
Date
Wmk
11103 1IM4 11105 11/DG 11/D7 11106 71/09
This
AG
280,75
136.98
173.90
17.90
OA6
0.06
0..
Noss
Pay Rats'
RAN For
Nuntbet
45"1 PARK ST#9
INDlO
Ltass'li-Gon
S
Prgjep
F1ojats
Week
140-Work" Eaeh Day
LAOORERIGRO
S
0.00
8.00
9.00
8.00
8.00
0.00
a.PD
< .00
0
62.a3
4
2, 9T,20
2,49720
Fund
TraH
Total
1,048.09
28459
CA
uP4
Training
Admire
Dues
*.4rbo
Savings
Other
Dedvot
0
0.00
0.00
0.00
1 0_oo
0.00
0.00
0.00
OAO
0.00
9nol
D
D.Oa
O.PD
0.00
O.DO
0.00
0.00
0.00
_
0.00
0.00
O.Oo
0,@0
0.00
0.00
0,op
901.80
1,851.it
626226679
178 4THER:901.60
Naeu,Addrersand
Nunibvor
bay
Deductions, eontrlbudals,aod Payments
Social 8acurky NumberorWarker
Nr4hhe1Grr9
Sun Mon Tue Wed Thu Fri Sat
Tgtat
Hourly
G-Ameunt
Earned
Earned
Fedarat
Tax
FICA
Slats
T
SDI
VOC1
Hmi
Hea1m
d wdf.
Pensio,t
Nat
Wage
L'Ma*
ANDRES FRANCO
0
Deft
W.e.
This
AN9;q
2.18
0-00
0.00
o.ca
11/03 1U04 11105 WON 11107 Wd 7rNi9
Hour
Pay Rate
PAW For
number
t227S SIERRA ROJO RD
VALLEY CENTER
�s�O�iOn
Pro)aU
Proje
Week
livers wortauf Each Dry
OPERATING
S
O.DO
8.00
-
8.00
8.00
6.00
0.00
0_00
32.tp
74,81
2.858.96
2,S6A
nv!
7.1.1
1,373.03
28460
CA
ENGiNEEI
Subs
Savings
Ducar
Deduct
0
0.00
0.00
0.00
.00
OAO
0.00
0.D4
O,Ob
0.00
UP 1
92082
D
D.00
0.00
0.00
D.00
0,00
4.00
0.00
0_00
0.00
O.Oo
0.00
2.134.06
1.491.93
613055757
I'M OTHER:1087.04
Nama.Addrassand
Number of
DaY
Daductims. Cemrbutions, and Payments
cu4er Sl S-rhy Numbof WerNer
Mhhgft"
son Man Tire W. Thu Fd Sat
6rosa Amount
Federal
Yad
HeaRN
P
Dare
Total
Hourly
Earned
Tax
FICAS01
tidlday
asV4R.
ydagt
CF1edc
ANDRES FRANCO
wok
11/03 11104 11105 11106 1IM7 Was 111OR
Now;
Pay Rale
This
AO
169.81
767,2542.1fi
0.00
0.00
On
Paid For
hkuaber
12276SIERRA ROJO AD
VALLEY CENTER
Gtani8cation
PZ'
Prgleas
Week
HouraWgrbdEoth Day 1
LABORERJGRO
$
0.00
0.00
6.00
0.00
OAO
8.00
moo
3.00
58.88
2,OW96
2,864.86
funtlTrav1
MO.
-
CA
UP 3
Training
Admire
Savings
Other
Tg1gi
1,373.03
28460
0
0.00
0.00
a.tk1
0.00
0.D0
0.00
0.00
4.00
OAD
DeOugt
90582
D
0.00
9.90
0.00
0�.Q0
O.00
0.00
0.00
0.00
0.00
0.00
0.0a0.00
0.00
2.134.08
t,491S3
819P58757
ME: OTHER:109744
Public works cefLifled aayrolT Reporting Fore 11/22/2015 - P49t 1
ntractor Name: COOKAND SOUS CONSTRUCTION Project Name! LA QUINTA SILVERROCK PARK VENUE For Week Ending: 11/0912019 Payroll Number.2-0
Name,Addressaed
SxWl Seturhy Number oM-k.r
Numberor
Wa "wI,tg
Lay
Dedue04rn, ContrWutlens, and Payments
Suo Non Toe Wed Thu Fd 3a1
Total
No-
Houdy
PSYRste
Grose Amount
Eames
Federal
Tax
-
Sate
Tax
SDI
Vas!
HaOday
HeaOh
8 WNL
Pc++Ron
yJage
Peid For
Week
Chalk
M.11-
0
Date
-
GALILEO LOPEZ
84S21 VIA DURANGO
This
Prajoa
R8
Projecle
23o.66
113.49
85,02
14.04
0.06
000
1 0.00
11103 11f04 11105 11106 11R17 11108 11106
Wok
Classi6 wn
Hours Wonted Each flay
COACHELLA
CA
92235
604921080
LABOREMRO
UP3
S
0.00
9.00
8.00
R.DD 4.00
8.00
0.00
36.00
S8.88
2.119.68
2,119.66
7rsiring
Fond
AdmiR
Dues
Travj
8tM
SeWnge
Olh-
Tgtat
864.23
460011
0
0.00
4,00
0.00
0.06 0.00
0.00
0.00
0.00
0.00
D.00
0.0o
0.00
ADD
0.00
011.44
1,2SSAS
D
0.00
0.90
0.00
0.00 0,00
0.09
0.00
0.00
0.00
M OTHER:811.44
Name, Address and
6ocW 5cwr4ty Number ofWorirer
Number of
1A4tbno6ding
Day
Owocu-, covartbu6ons, and Payments
Sun Non Tue Wed Th. Fri Sat
oat.
Total
ilpUf4
HWAy
Pay Rate
Grass anouat
Famed
FedsrN
Tan
Ff CA
Stan
Ta:
�t
Vas!
Holiday
FieaM
6 WeH.
Pew
Wa9a
Paid Far
WIG
CMG
Nq w
0
LUZ VEIASOUE2
66617
1t103 11ID4 11105 1IM6 11/07 11108 11109
-rn�
Pmjed
Ad
Projects
12285
143.67
47.53
117,50
0.00
OAD
0,00
Wyk
Classficarwn
Hours Worked E71 b Day
DESERTHOTSPR NGS
CA
42240
625017899
tAeOPERiGRO
UP3
$
0.00
5.00
8.00
0,00
0.00
0.00
0.00
24.00
58.88
2,6t0.00
?,610.08
TroWtn8
pFund
d�
Duaa
Tw/
Savings
Dinar
To1a1
7,29293
16O0T2
p
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.DO
0.00
0.00
0.00
0.D0
0.00
0.00
t,960.64
1,31775
D
0.00
0.06
0.00
0.09
0.00
0.00
0.00
0.00
0.D0
r1E: OTHER984.32
Name,Address and
SoeWt Security 11-heraf Worker
Numdar o1
Wlhholdmg
y
Deductlgns, Crmtribudans, and PgmenW
gun Non Tue Wad Th. Fri Sat
6aW
7ota1
Na1u5
Hourly
Pay mate
Grass Amours
Famed
FedeW
Tax
I=
Stara
Tax
Sot
Vat!
K.Rda y
Health
Awed.
P.1w
Net
Wage
Paid Far
Week
C""
M-tlar
0
LUZ VELASQUEZ
Gfi61T
11M 11f04 11M 11106 11107 11108 11109
The
Project
Al
Pnlj4us
122,85
143,67
41,51
37,16
0AO
O.OD
0.00
Wqd:
Cias476t10ien
HWrs Worked Each Oay
OESERTHOTSPRNGS
CA
92240
625017899
OPERATING
EHCs04EER/CRO
UP 1
S
0.00
0.00
D.00
0.00
8.00
&OD
0.00
16.00
74.81
2,5t0.08
2,fi10.08
Training
Fond
Admin
Does
Trav!
Sum
SauigOs
Other
Total
1,292,93
460072
O
0.00
0.04
0.00
0.00
0.00
O.OD
0.00
O.bD
O.W
0.00
0.00
0-00
O.OD
0.00
1,968A4
1.317.15
D
OA0
Q00
0.00
O.OD
0.00
OA0
D.00
0,g0
0 be
Tlw: 0TNER:984.32
Public corks certified Payroll Rep-iqq rorm 11J22f2019 - Page 2
eCPR Form 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@dicca.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; 2019-11-09
Payroll Number: 2
Amendment Number: 0
6 employee payroll record(s) processed
Your Transaction ID is: 7084923
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