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2016-08 Cook and Solis Construction WE 2019-11-30-1. KAY COOK, the undersigned, am the PAYROLL ADMINISTRATOR (position in business) with the authority to act for and on behalf of COOKS SOUS 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 2019-11.23 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 farm to the individual or individuals named. I certify, this on 2019-12-06' ntractor Name: COOK AND SOLIS CONSTRUCTION Contractor PWCR: 1000367967 License Type: CSLB License Number 462446 dress: PO BOX 310491. ESCONDIDO, CA 92030 FEIN: 330045043 Contractor Email: KAY@COOKANDSOLIS•COM ,umnce Number: US-8K111810-19 re rding Body: THE CITY OF LA QUINTA DIR Project ID: 300347 Project Name: LA QUINTA SILVERROCK PARK VENUE atract With: URBAN HABITAT County: RIVERSIDE Location Description: LA QUINTA SILVERROCK RESORT yrotl Number. 4- 0 For Week Ending: 11/2312019 Ots this a -Statement of Non -Performance?' Nance, Address and Soalal See" Namber of Worker Number or Wim"Id198 Dsy OWucllens, Cantftenl s, aad Payment Sun Mon Tue Wed Thu Fri Sat - Total Hours ttoudy Pay Rate Gross Amount earned Federal Tax FICA I Sta1a Tax SDi VaU Holiday Hsaah Q Well. Pension Net "Vog- Paid For Week Cneeir Number Dax 0 ALFREDO FEDERr1 45481 PARK ST:9 T, Prole., All Projeeta 242.11 123.65 $2.24 TGAS 0.00 0.00 0.00 yyrk el irkaOon a 11117 11110 11119 1120 11,21 11122 11123 Hoes Milled Each DW INDO CA 92201 626=6679 LABORERIGRO UP4 $ 0.00 0,00 8-00 8.00 BAO 900 0.00 32.00 82.43 1,997.76 2,22I'le Tratntna Fund Admtn Auer Tray/ Sups Sav'Rsgs Other Toler Deduct 1 036,32 28470 O 0.00 0.00 0.80 0.09 oon I 0.o0 I 0.00 0.Qa 0.00 0.00 0.00 0.00 0.00 0.00 721,28 1,185.44 p 0.00 0.00 0.00 0.tq 0.00 0.00 0.00 0.00 0100 31E OTHER:721.28 Name, Address and Soeul S-611 IJumber ofWerker NYMOer d Vlrthholdl Day r Dedaedons, Conttibutlens, - Pay-111 Sun tlon Tug Wed Thu Fri Sat T.-Hoveyn1Od Haws Pay Ratc Caoas Amount Federat Tax BOA Stare ias SDi vac? Hotkray Hp6h 6 Wen. P°`1°iOd Wage .Paid FW Weak Ohedk Number, O Oatb ANORES FRANCA 122TS SIERRAROJO RD Ttdt PrajeU ProjeU9 766.02 152.47 62.65 39.86 0.00 0.00 0.00 11117 itl18 11119 11020 itr21 1122 1123 Won Classl .Wr, hours Wo;arked 0.y VALLEY CENTER G 92082 GIXS8757 OPERATING ENGINEERKiRO UP 1 S 0.00 8,00 8.04 0.00 0.00 6,00 0.00 Za.00 74.81 2.73TS2 7 2,737.5. Train' t� Fund Admin Dues Subs Sups Savkl>N Other Total Oeduct %320.77 28471 O 0.00 OAO 1 0.00 I 0.00 1 4.00 00o D.00 0.00 0A0 0.100 OAO 0.00 0.00 0.00 2051.36 1.516.75 p 0,d0 OAO I 0.00 I 0.00 0.00 0.00 0.00 0.00 0,00 >TE: OTHER:tO%.6a Name, Address and Social Security Number of aFarker Numpes Or W'thnoldi" Oay ❑eduNens, Conwrhu0ons, and Payments Sun Mon Tue Wed Thu Fri Sat Date Total sblaf HWdy Pay Rala urosa Amour. Earned Federal Talc FtOA Stele Tea SDI Vat! HOIIday 1re:8h 6W ff, Pension Yvage Paid For Week Gheik Numbsr 0 AN(MES FFU.NCA 12275 SIERRA ROJO RD 71f7T ti118 11779 11/20 11R,1 11722 1123 This Pre'xt 0 A8 P raldtts 156,d1 152A7 62.85 39.86 0.00 0,09 0,00 yM+k chs sRea[iwt Fours Worked Eacn Day VALLEY CENTER CA 92082 613058757 LABORER7GR0 UP3Admtn $ 0.00 0.00 U." e_00 8.00 0.00 O W 15.00 58.88 2,737,52 2,Y37.52 TrainingFund trues S.W Sups Savi Other 7G13I txduu 1,320.77 28477 p 0.00 0.00 0.00 0.00 0.00 0.00 I 0.00 0.00 0.00 0.00 0.00 0.00 0A0 0,00 2.057.36 tp t6.75 D 0.00 QAO 0.00 0.00 ODD 0.90 0.00 O.Od 0.00 re; OTHEfi7025_69 Public works Certified Payroll Reporting Fom 12/06/2019 - Page 1 ntractor Name: COOKAND SOUS CONSTRUCTION Project Name: LA QUINTA S[LVERROCK PARK VENUE For Week Ending: 1112312019 Payroll Number.4.0 Name, Address oral Satl>t Setugly Numberar Worker Numtlerof Wlthholdn9 _ OSY Dad-d-s, Comrlbu8ana, and Paymerls Sun Mon Tut Wed Thu Fri S. Tote] Naura hway Pay Rate Grass Amount Eamed Ftdera[ Tax FICA StatS Tar SOt VaG M-141y Health d Wtlf. pe�1lpn Net Wagt Paud for Weak Ch¢dt NummK 0 GAUUIOLOPEZ 845271AA DURAraGO M� T1117 11/18 11119 1tt24 11r2] 11M 17M Thin Pmftct AU Projects 262.40 124,53 99.77 16.29 0.00 0.00 0.00 Wo0, CUrslf ow. Mon Worked Each" COACF40.L4 CA 92234 804921060 LASOR6r#GRO UP 3 $ 0.00 84G 800 9-00 6.00 7_SO 0.00 39.50 58.88 2,325.74 2.325.78 Training Fund Ad00 0uas Trawl S;MnNe Omer Total 932.45 480411 p 0.00 0.00 040 0.00 0.00 0AO 0.00 0.00 0.00 0.00 OAO 0.0p O.OD O.DD 0.00 880.35 1,383.33 D D,DD 0.00 0,00 0.00 0.00 0.00 0.00 D.00 0.00 YrE: OTHER:B9D.75 Name,Addraasand Sattai 8eanr#ty Number Pf W~ tdurrt)aiU W4hha1dm9 0 Dew O-h-M .Cenusbuuw -0 PaYnxnts Sun Man Tut Wed Thu Fd Sa, Total H-M Nwrfy Pay Rafe Cori Amount Earned Ftdenl Tax FICA Sett Tex SO1 VPU Hokdey Heaifh d WrrN. Pension Net � Paid For Watk ta+tc% Number RICARDO LOPEZ ta65 2ND STREET Oate yya� Ctassifi inn 11117 11/18 11119 11120 11127 11122 1112Z This Project A0 Projects 211,82 12S.47 03.53 32.80 O.DO 0,00 0.00 Haas Worked Eadl Day COAta1ELLR CA 92238 S54618002 LABOREWRO UP 3 S O.DO 8A0 B.DD 0.00 8.00 ?,SO 0,00 3t.59 $B.88 2,338.14 2.338.18 Tntrrrg Fund Ad., orris Subs S." sw.Fnp Omer T lal 1,000.61 28469 p 0.00 0.00 D,Op 0.f?0 0.64 0.00 0.00 0.00 0.00 0.00 D00 0.00 0.00 0.00 1.780.70 1,337.57 D 0.00 D.DD Dm o.Da D.Do GAD a0o 0.00 0.00 fE: OTHER:890.35 Name, Address and sac,. Se-MxYNumbsrof Warxar M..t rof wdhh.W.9 DaY Deduadona,Con01br10ona, and Paymtnls Sun Mon Tut Md Thu Fri Set To1a1 Hours HouRy Pay Rate Grass Amaant Eamatl Fadtrsl Tax FICA S1src lax StN VsrJ HdldeY Hea1m 8 WdB. Ptraion Net w-ge Paid Far Wt& Cheer NuaMrr 0 Dam RICARDO 40PEZ 14652NO STREET This Project All Projecrs 211.82 12$.47 93.53 92.80 0.00 0.00 QDO tlnT 11118 11/19 11120 71121 71,22 11/23 - Way Glassi5alion Noars Waked Each Day COACHEUA CA S64618002 LASORE70GRO UP 4 S 0.00 0.00 0.00 a.00 0.00 O.OD 0.00 8.00 60A3 2,338.16 2,338.1E T.I. Fuhtl Adman Dues 7rav1 Subs Savings Omer Total l,000.61 28469 p D.00 0.00 O.Oa�00-"64 DAO D.OD 0.00 0.0092236 0,00 0,00 0.00 0.-1.780-70 1.337.57 D D,00 0.00 0.0O.00 D.O0 a.o0 o.tw E: OTHER:800M Name,Addresswd Saalsl SeeudW Number a Worker NumlltrW Wnhhofdin9 Day Otduedans, Conb]buHorm, and Payuuents Sun Mon Tut NNd Thu Fri Sat Date Twal Ham H-dy PaYRa4 Gross Ameun2 Eamed Fedrat Tax F]CA State Tax SOi vw Hofiday Healm d Wetf. P.-Net we" Pad Fos Wtak Cfwck Namur 0 SERGIO Lr3PEZ,pL 845311M OURMGO - it117 11116 15ft9 1120 i1uX1 11122 it R3 This PrujeC All Pmjee7s 2a7,36 l25.aT 94.53 32.eb 0.00 000 4.D0 Work C1as161wdan tfaxs 1Y11kta Eger Oay COACHEL A, CA 92236 817522695 LABORERJGRO UP4 S 0.03 0.00 0.00 0.00 8,00 0.00 0.00 8.00 60A3 2.336.16 2,33$18 Tainin9 Fund Adunfn Duna Traurl Sty Smirlgs Other TWA 960,07 48COM p 0.00 0.09 D.00 6.00 0.00 0.00 4-OD D.Do O o0 0,00 0.00 0.00 0.O1i 0.00 1.780.70 /.378.11 D 0.00 0.00 0.00 0.00 D.DO 0.00 O.oD D.00 0.00 : OTHER:890.35 Public Works Certified vayrall Re"ming Farm 12/06/2009 - Page 2 ntractor Name: COOK AND SOUS CONSTRUCTION Project Name: LA OUINTA SILVERROCK PARK VENUE For Week Ending: 1112312015 Payroll Number: 4-0 Nam.. Add— and 6acyl S.-Ift Number of Worker Number o1 WHhhold:hg D+Y Ded„cnaM, c..wi uttn' and P.y-.b Sun Man Tut Wed Thu Fri SM Date Total Hours Hcwrfy Pay Rate GnuY Amount Earned Fetleraf Taz I. $[ate Tax $� Vac/ Hoiday Health i Wen. Penskn Nei Wag. Paid Fa West Ct ok Number 0 SERGIO LOPEZ JR 84531 VIA ANGO GOAGHELIA 11117 11/18 11119 111?F 11121 11 r22 11123 Tnis Projeq A4 Projects 17- 125A7 D8.53 32.80 0.00 am 0.00 Wok cla. Galion Hours Wwkad Each Day _L CA 22236 617522996 LABORERtGRO36 VP3 S 0,00 8.00 S.De 3,00 0.00 7,50 0,00 31 Sp 58.8@ 2,338,76 2.338.t@ Tr#fining Fund Admire Ocres Travi Subs Savings Olney Tat 960.07 480007 p 0:D0 0.00 D.00 0.60 0.00 0.00 0.00 0.p0 DAO 0.00 0,00 0.00 0.00 0,00 1,790.70 1,375,11 Q 0,00 1 O,OD 0.00 O.OD 0.00 0.00 O.DO p OD 0 W 1E: OTHER swu Name. Add -and Sawal3-dWNU.1xr tWorker Numb. or WrtMown9 fty Deductions, COMrWutlont, and Paymnta Sun Mort Too Wed Thu Fli Sat To1.1 Hours Haudy Pay Rate Gross Amount Earned Fed-- Tax FICA 5tato Tax SD7 Vad HNiday Neellh i Weli. Pension 1e g Paid Foe Week Chadk r4urgy DAGOBERTO MANZO P O BOX 1377 MECCA 0 (late 1V17 11110 11/19 IV20 11121 11122 11123 Work cl.tir-awl .� Project AO F.j.gz 83.9ff 73.BS 2D.83 9.65 /34.70 0.00 56.3fi Hours WaAmd Safi Ila1' CA 92254 621742124 LABORERIGRO UP APPRENTICE LEVFl2 S 0.00 8,00 BAD 8.00 8.00 7.50 0.00 39.50 21.03 690.69 1,309.46 Training Fund Admire W� 71-tSub. 5upa Savings Otlur Total 633A0 28472 O 040 0.00 0,00 0.00 OA0 0.00 D.00 0.00 0.00 2726 0M 0,00 D,IXI 0.00 729.20 676.05 D 0-00 0.00 1 0.00 1 0.00 0.00 p.00 0.90 0.00 OAO E O7HER24,10.HFdLTHSAMP;SAFETYFUt4D:20659ANNURY:79.75OTHER:478.76 Name. Address and Serial Seen Number of Wedre *Y N.,rA-of WlDshoidlrt9 _ Dry 0adualere:, Oomributlars, one Paym.nla Sun Mon 7ue Wetl Thu Fri Sat Date Tola1 11WrY Ho , PaY Role Gross AmeuM earned Fe- Tax FICA Stare Taz 8D7 Noway owe i WeB. &"loth Peruion Nee W. P31d For W� Chedt Number 0 UJZ VElASQUEZ 86817 QESER7HOTSPRINGS 11117 11/15 I7119 11/20 i1121 17/22 11123 -1 Project AM P-*ft 12255 143.68 47.53 37,50 0,00 O,OD 0,00 yty.k Olaasifica0on Hours Wo ked Each Day CA 92240 62SOITS99 OPERATING ENGIWERIGRO VP t $ 0.00 e_00 0.00 6.00 6.00 0,00 0.W 16.00 74.61 2.610.08 2.610.08 Tr,rxn g Fund Admire Ows Tra1dSuh1 SaAnq. 01her Total 1.29?,92 i80072 O 0.90 0.00 0_D0 0.00 D.00 O.Od 0,00 0.00 O.OD O .DO 0.00 0,00 O.OD 0.00 1.966.1i4 1,317,t8 p O.pp O.OD 0.00 O.OD 0.00 0-De 0.00 10.00 0.00 OTHER:984.32 Naatt. Address and i4dal Sa ty Number of woos' alon",of Withhoid4g coy Deduott n, OonMbulknz, and Paymetds Sun Man T.. WW Thu Fri Sal Totol Haut -ay Pay Rat4 GransA-.14 Earned Tax FICA Taz Sol i Vad Holiday Heann 8VYeS, Penekn NM Wage PNd For W.ek check Number LVZ VEIASQUE2 6661] 0 Pate ti/17 11110 11119 tlr40 bill W22 11123 Work Clazsi6eafod T1nS Projen Afi Projects 1?1&S 143.66 47.53 37.58 O.qp O.OD O.fiO Hawn WwOad Ea.h Day AESERTFIOTSPRINGS CA 922a0 625017899 LABORERIGRO UP3 g 0.00 6.00 8.00 D.00 0.00 8.00 0.00 24.00 S8,S8 2b70.0B 2.6/0AS Trainin Fund Atlmin DUNS Traw u'rbs Servings Other Total 1,292,42 490012 13 0.00 0.00 0.00 0,00 00e 0.00 0,00 0.00 0.00 O.Od 0.00 0.00 0.00 0.60 1,955.84 1,3t7,18 D O,Op O.00 0.00 am am OAF 0,00 0.00 0.0D OTHER:934.32 Wblic nark: cencified Wyroll atpoRing Farm 12/06/2079 - Page 3 ei,vm rorm Hppilcatlon CA.gov I Contact DIR I Press Room Search { i "I'itis Silo California V01M L61POP LaW Cal/CMMA.- Sa%ly'" & Health WCWkore' Camp Saa Insurance AWwnk#a"hip Diractor's Moe Board® Public Works eCPR System - Online Form 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 pu blicworks @d I r.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: 2019-11-30 Payroll Number: 5 Amendment Number: 0 9 employee payroll record(s) processed Your Transaction ID is: 7169191 Print this Page R View your submission , Adobe https:f/efiling.dir.ca.govleCPRlpages/eCPROntineFormPreFili.jsp 1/2