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2016-08 Cook and Solis Construction WE 2019-11-16Oflc46o0 under penalty of perjury: 1. KAY COOK, the undersigned, am the PAYROLL ADMINISTRATOR (position in business) with the authority to act for and on behalf of COOK & SOLIS CONSTRUCTION INC. (name of business and/or contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll retards for the week ending 2019-11-16 are the originals or two. full, and correct copies of the originals which depict the payroll records), of the actual disbursements by way of cash, check or whatever form to the individual or individuals Hamad, I certify this on 2019-12-04: ltractor Name: COOK AND SOUS CONSTRUCTION Contractor PWCR: 1000367967 license Type- CSLB License Number 462446 trees: PO BOX 310491. ESCONDIDO. CA 92030 FEIN: 330045043 Contractor Email: KAYQCOOKANDSOLIS.COM arance Number. UB-8K111810-19 arding Body: THE CITY OF LA QUINTA DIR Project ID: 300347 Project Name: LA QUINTA SILVERROCK PARK VENUE %tract With: URBAN HABITAT Calmly: RIVERSIDE Location Description: LA OUINTA SILVERROCK RESORT 'roil Number: 3- 0 For Week Ending: 11/1612019 Cis this a'Statement of Non -Performance'? Name, Address and 3os1a1s-ftyNun11f. rWorker Nun"' a V"Mhadin9 Day Deduct[-, Contrlbudens, and Paymsnls an Mon Tue Wed Thu I'd Sat Hcurs Howdy Pay Rate cress Amould a Emed r-ederal Tax FIB Stato Tax �I Vad Holiday Heats S Wed. Pardon Net Wage Paid For Yspak Check N-zer ALFREDO FEDERICO 45461 PARK 5T e9 0 DateI. Work Classification 11110 11111 11112 IV13 11114 11/1S 11/16 This Project All Pro" 216.40 114.71 $4.14 15.00 OA0 040 0.00 Hours Waked E oh Day =10 CA 92201 M226679 tAgORERUGRO Up4 S 0,00 0.00 8.DO fiA0 8.00 8,00 0.00 32.00 82.43 2,080,14 2,081.43 Training Fund A6mM Doer T1av1 svi. Savings Other Total Oaduct 906.07 28464 Q 0.00 0.00 OAO 0.00 0.00 1.00 0.00 1,00 02.38 0.00 0.00 0,00 0.00 0.00 755,11 1,185.38 D 0.06 D.00 D.00 0.00 0.00 Q08 O.Od 0.00 0A0 rE: OTHFR755.11 Name. Address and Soeisl Seeurky Numberof Worker Number or V00holaing Oay Deduct[ons, Carultmdern, and Pxymenls Sun taon Tue Wad Thu Fd Sat Tor. Hours Houry Pay Rafe Groan Ahnoenf Eametl Psdonf Tax ' 8euo lax sp Vad HODday Hedrh 6 Wa0. i Net ,fie Para Fw W.),Han Ctkek Number ANDRES FRANCO 122T6 SIERRA ROMRI)Claast.ak. 0 Pale 11110 11111 11112 11113 NM4 11/1S 11116 Work Thu Projott AO Projach 106,39 120.82 32-77 31M 0.00 0,00 OAO VJarbsd Eatlh Day VALLEY CENTER CA 920ffi 613a58757 OPERATR40 ENGINEERAaMiO UPI 5 000 000 8.00 8.00 0.00 0.00 0.00 18.E 74.81 2,177.57 2.103.21 Training Farts Adm/h Dues Tray/ $ILr Savigs cow Total IDplud 1,0$8.53 28485 Q 0.00 0A0 0.00 0.Do 0.00 OA0 0.00 6.00 0.00 0.00 0.00 0.00 0.00 0.00 1,641.82 1096.68 D OAO O.W 0.00 040 0.00 0.00 0.00 0.00 9.00 E 07HER;82O.9t Name.Addrerdand Socials-tty al-btrofWaakar Numtaf of W+ONwlding ray DaduNons.c-Vawsona.-M Payments sun Mon Tue Wed Thu FA Sal Total Hoes "Wny Pay Rate Gross Amount Earned Federal Taz FICATaz State SDI Vad Hafiday Health AWN( Perh&on wage Paid Por Woak Chock PaunMer ANDRES FRANCO 12275 51ERRAROJO RD 0 oats Wank flassi0caddn 11110 11/11 11/12 11113 11114 11/15 tilts 'fihil Projacl All Proper t06.39 120.92 32.77 31.58 O.00 OAD (?.Do Issas Worked Each t3ay YALCEY CENTER CA 92082 613OSS757 lABORER/GR0 UP3 S 0.00 0.00 0.00 D.00 8.00 &00 0.00 16.00 58.88 2,777.57 2.te32i Training Pots Admin Dues Travl Subs Smnps Oder Total Dedudt 1,086.53 2a465 p Q.OD 0.00 0.00 0.00 O= O.SO 0.00 0.50 71.05 0.00 0.00 O.00 0.00 OM 1,641.82 1A96.68 D 0.00 0.00 0.00 0.00 0.00 0A0 0.00 0 00 0.00 OTHER620.91 Public irerkd certified Payroll Repo King Form 12/04/2019 - Page 1 it -tor Name: COOK AND SOLIS CONSTRUCTION Project Name: LAQUINTASILVERROCK PARK VENUE For Week Ending! 11M612019 Payroll Number.3-0 Han, , dmn and Number 0! Day Dada! -.. Conalbuu-., and Paynlards Social 9-HY Number of W9rker Wlthholdin9 Sun Mon Tue Wad Thu Fn Se! Total F1oaHY Gross Amowrd Samatl Fad- Tax FICA 5Urc Tax SDI VaW Ho64a Y HeaNh &WaN. Pemba Oat Wage CneGk (iALREO LOPE2 0 Dale 11111 11112 11/13 11114 11115 11/16 Ties A$ 20120 103,25 71,31 13.19 0.00 0.00 0,00 84527 IADIJAWo* H.- Pay Rafe Paid For Number AcKEL A COacHELf.A C9.,ocaton - Prgaet Prgeds Week Hours Wa&ad Eaol Da Y IABORE70GR0 g 0.90 9.00 8,09 0.00 8.00 B.00 0.00 32.00 58.68 7,92289 7.928.33 Fund T-1 _ &00.09 470011 CA UP3 TrabUn9 AdrMn Duet Sbvwgs Ocher :alai 11-1IO O 0.00 0.0D 0.00 6.00 0.00 0.50 0.00 &50 77.05 92236 604921080 D 0.00 4.00 0.00 0.00 OAO 0-00 0.00 0.00 0.00 9.t10 0.00 0.00 0.00 D.00 73819 1,12T,44 "f: OTHER738,19 Nafae.Addretsand thwn- ...Dal' Dedueftm, Cortdbutom. and Paymalds Social S-ft Nunberot Worker wehMWin9 Sun Mon Tue Wad Thu Fri gat Ho Gross Anwnm Federal TaxFICA Sn1e Tax SDl Wei eloGdaY Naafh & WeN. P4-YJ-eTotel ayy/n,a RICARDO LOPEZ 0 Oat 11110 11111 11112 11113 11114 1111g 71116 AN 187.89 103.25 83.81 13.50 0.00 0.00 0,00 STREETClasaidcaii0n Hares Pay Rare�E-d Paid For NumberT4662ND COACHELLA Hisµy,k�>� �Y d Projects vdeek L480RER/GRO S 0-00 p,00 $,00 B.OD &00 0.00 6.00 32.00 58.88 1,822.69 7,928.33 Fund TravJ 861.69 28463 CA tJP3 7rainin 9 Adm1n Ones Subs S.-A aPa pMer TOUT O 0.00 0.00 D.00 0.W 9.00 0.50 0.00 p,50 77.45 92236 D 0.00 D.DO D,OO 0.00 0.00 0.00 0.00 0,0p MAO 0.00 0.00 0,00 0.00 0.00 736.19 7.066.64 554618002 B OTHER736.19 - - Naaq, Adlkess and Numherat DaY DedueBona. Gonblbu0ana, and Prymenh S.. S-edly a8lnlber et Worker Whhhawln9 Sun Man Tue Wed Thu Fe Sat To1a1 Howdy Grans Ameunl Em11ad Federal 7az FICA SU1a Tax SDI vaU K-Aday NeaKh &WeN. PC0' 7"h9a � SERO:fO LOPE2JR. 0 Dam YYor4 This A8 183,41 10325 18.11 13.50 0.00 0,00 MAD N/i0 11171 11/12 i1113 14/11 717/5 tilt6 tloun; Pay Rate Paid For Hunt- 94531 YIA DURANGO COACHEL A, Ctassda0on Project Project Week Hour 1NpNJd East Day 1ABORER/GRO S 0.00 0.00 &D0 800 8A0 8.00 0.00 3200 S8.$8 i,922.69 i,928.33 Pond Lav1 821.76 470017 CA UP3 7rakin9. Aomin Dues Subs Savirg6 Other Total O OAO 0.00 4,ixi 0.00 0.00 OSO 0.00 D.50 77.05 92236 617522695 I D 1 0.00 1 0.00 1 O.DO 0.00 0.00 _ 0.00 0.00 0.00 1 0.00 0.00 0.00 0.00 0.00 0.00 738,19 1.101,76 E: OTHER736.19 N-ne, Addross and NumberM DaY F. DWuettena, eonmlwdlons, and Payment Sedal5-ft Nurtlke ww.,aar Wtlhhetdinq Sun Mon Tue Wsd Thu Fd Sat To1ai HW M Grass anoant 6a Paden4 Tax FICA State Tax SSol VaU Holiday Had01 &WfJf. Fernion Net Wage CheaR DAGOBERTD hWNZO 0 Dale VYo* 11110 11/11 11f12 fiff3 WIA 11115 Wle TIYa AN 63.53 60.83 _ 17.99 7.96 0.D0 0,00 0.00 DOEOX 7377 Ho1¢5 PaY�e Paid Fp Number MECCA CUzsifika0en Project Projects Week Ham Wddald Each Day IABORERfCRO S &00 OA0 B-00 8.00 0.00 8,00 0,00 32.00 33.15 1,082.69 1,085.&s Ford 533.17 28466 CA Up 1 Training Adm n Dues Sub. Subs Savlryl OOw_r TOUT O 0.00 0.00 OAO 0.00 0.04 4.50 0.00 &50 43.67 92254 APPR£N7iCE 621742124 LEVEL2 D D.OD 0.00 D.00 0,00 OAO D,00 0.00 9.06 D.00 0.00 0.010 omo 0.00 0.00 402.36 552.67 L OTHER:402.36 Publi, works Certified Payroll aeoorrinq Fan 12/04/2019 - aage 2 proctor Name: COOK AND SOL]$ CONSTRUCTION Project Name: LA QUINTA SILVERROCK PARK VENUE For Week Ending: 1111612019 Payroll Number: 3-O Name. Addl.-d So<Ia1 Ssca+;y Number of Worker NPmbar Ml Wdhboklln9 Day Deduce-, CenlHbu6ona. and Payment Sun Man Tue Wad Thu Fri Sat Total Mama Ho RA' Pay Rate Gras. Am.- Earned Fadara[ Tax FICA Staro Tsx SDI VaG F1o5day HaaMh b Wey. Pension Net wage Paid For week Check Number W2VElASOUE2 66a17 DESERTY{IT3PftlNG6 0 Date 11ft0 11/71 a1f12 11113 11114 711/6 11116 VydrlC classification This Raiee! Ms Projects 88.29 121 AS 26.41 31-M 0.00 1.01 0.00 Hours Worked Each Day CA 92240 6250,7999 i g6O"` R7O UP3 S 0.00 0.00 8.00 6.00 0,00 0.00 0-00 16.00 58.98 2,768,22 2,19a,78 7ra{nirq Fund AdMn Wes TravJ SYOi Savings 0d�6r Total 1.116.05 470012 p 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0�0o 0.00 O.CO 0.00 0.00 OAO 1,548.62 1.Oy6.i3 D 0,00 O.W 0.00 0.00 DAM 0.90 0.00 0.00 0.00 7E: OTHFR:624.41 Name.Addressand Social 6ecursy Humber of Worker NraMer of WIhholdhV MY Ded-Oros. Cantrewtions,-d Payment Sun Mon Tue Wed Thu Fd Sal Total siaaa Mowry pay Bala Gress Amount Fame) F4Warl Tax F Sgro Tax SW tlerJ Holiday Health SWe�. Peoamn Wage a PaidFor! Week Chock a4m+ber t,U2 v 9617 VE2 66677 DESERTHOTSPRtNGS 0 Date Wok classification 11/10 11I17 111/2 17 f13 11194 91115 17116 T1a T Pmiea AN Proieels 86.29 721.55 2E.48 37.64 0.00 0.00 0.00 - Hours Waked Each Day CA 92TA0 625O17e99 OPERATING ENGiEWINGEENGR UP1 S D.00 0.00 O.DO 0.M0 6.00 8.00 DAO 16.D0 74.61 2.186.22 Z194-78 Trairtin9 rum Admen Dues Trevf SWs Savkgs Othk Total 1,116A6 470012 0 O,OD 0.00 0.00 0.00 0.00 OM 0.00 0.50 9836 0.00 too 0.00 o.00 0.00 1,649.e21,MT6.rs D M.00 DAD 0.00 1 0.00 0.00 1 0.00 0.110 0.00 1 0.00 M OTHER:82J.41 Public Irmrks CemiFled Payroll Reporting Corm 12/04/2019 - Pape 3 ewrrc t-orm Hppucataon 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 pubticworks@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: 2019-11-16 Payroll Number: 3 Amendment Number: 0 9 employee payroll record(s) processed Your Transactlon ID is: 7148045 Print this Pagp r View your submission Adrbe https;/Iefiltng.dir.ca.gov/eCPR/pages/eCPROnlineFormPreF!11.lsp 1/1