2016-08 Jacobsson Engineering Certified Payroll201.54
3306.34
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $4.87/$4.87, Health & Welfare: $7.47/$7.47, Pension: $8.40/$8.40, Training Fund: $0.69/$0.69, Administrative Fund: $1.11/$1.11
0
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
0 1.0000 0 46.011.00
0.00
0.00
0.000.00
449.89 177.76 0.00
0.00
1101.91 2204.43
000002817
0.00
272.72
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
46.01
14710960
Other Deduction Detail: Vacation: 272.72
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
1.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/10/2019 2016-08/2016-08
4 5 6 7 8 9 10
Medicare
MON TUE WED THU FRI SAT SUN
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 #1.1
Jacobsson Engineering Construction (a sub of Urban Habitat)
4th
Payroll Supervisor
January 8th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019November10th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, State Tax, Vacation
130.95
1711.68
Desert Hot Springs, CA 92240
65565 Acoma Ave.
Fringe Detail: Vacation/ Holiday: $28.40/$3.55, Health & Welfare: $92.80/$11.60, Pension: $77.20/$9.65, Training Fund: $8.40/$1.05, Administrative Fund: $15.28/$1.91
0
0Operating Engineer:
Group 8
0
Michael Birdsall
S
D 0
0
00000
0 8.0000 0 53.498.00
0.00
0.00
0.000.00
381.24 158.35 0.00
17.12
801.26 910.42
545020271
0.00
113.60
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
427.92
8166045
Other Deduction Detail: Dues: 113.60
36.43
2512.25
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $43.83/$4.87, Health & Welfare: $67.23/$7.47, Pension: $75.60/$8.40, Training Fund: $6.21/$0.69, Administrative Fund: $9.99/$1.11
0
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
3.00 2.002.00 2.00 0 46.019.00
0.00
0.00
0.000.00
343.48 132.14 0.00
0.00
740.94 1771.31
000002817
0.00
228.89
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
414.09
14757168
Other Deduction Detail: Dues: 228.89
56.38
737.00
Mecca, CA 92254
65361 Palomares Cir.
Fringe Detail: Vacation/ Holiday: $9.00/$3.00, Health & Welfare: $15.69/$5.23, Pension: $5.04/$1.68, Training Fund: $2.07/$0.69, Administrative Fund: $3.33/$1.11
0
0Laborer/Group 1
3
Abraham GallardoOlloqui
S
D 0
0
00000
0 03.00 0 0 22.533.00
0.00
0.00
0.000.00
46.86 11.67 0.00
7.37
233.11 503.89
612250726
0.00
110.83
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
67.59
Apprentice Level 1 8166047
Other Deduction Detail: Dues: 110.83
104.21
1362.23
Murrieta, CA 92562
23770 Fieldcrest Lane
Fringe Detail: Vacation/ Holiday: $88.75/$3.55, Health & Welfare: $290.00/$11.60, Pension: $241.25/$9.65, Training Fund: $26.25/$1.05, Administrative Fund: $47.75/$1.91
0
0Operating Engineer:
Group 8
9
Scott Helm
S
D 0
0
00000
8.00 8.0008.00 0 53.4924.00
0.00
0.00
0.000.00
63.74 50.13 0.00
13.62
320.45 1041.78
553530862
0.00
88.75
1)
2)
3)O 0 0 0 1.00 0 0 0 1.00 78.47 0.00
1362.23
14757172
Other Deduction Detail: Dues: 88.75
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
2.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/17/2019 2016-08/2016-08
11 12 13 14 15 16 17
Medicare
MON TUE WED THU FRI SAT SUN
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.
109.98
1437.49
Palm Springs, CA 92262
2230 N. Whitewater Club Drive
Fringe Detail: Vacation/ Holiday: $116.88/$4.87, Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Training Fund: $16.56/$0.69, Administrative Fund: $26.64/$1.11
0
0Laborer: Group 3
3
ROBERTO MARTINEZRECENDEZ
S
D 0
0
00000
8.00 8.0008.00 0 41.2124.00
0.00
0.00
0.000.00
108.73 28.41 0.00
14.37
427.07 1010.42
616314224
0.00
165.58
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
989.04
14757186
Other Deduction Detail: Dues: 165.58
104.02
1359.68
Coachella, CA 92236
84332 Capitola Ave.
Fringe Detail: Vacation: $121.75/$4.87, Health & Welfare: $186.75/$7.47, Pension: $210.00/$8.40, Training Fund: $17.25/$0.69, Administrative Fund: $27.75/$1.11
0
0Laborer: Group 2
8
Francisco Rios
S
D 0
0
00000
8.00 8.0008.00 0 40.6624.00
0.00
0.00
0.000.00
41.24 9.16 0.00
13.60
328.73 1030.95
604194135
0.00
160.71
1)
2)
3)O 0 0 0 1.00 0 0 0 1.00 58.56 0.00
1034.40
14757199
Other Deduction Detail: Dues: 160.71
109.40
1430.03
Moreno Valley, CA 92557
12379 Kitching St.
Fringe Detail: Vacation: $160.71/$4.87, Health & Welfare: $246.51/$7.47, Pension: $277.20/$8.40, Training Fund: $22.77/$0.69, Administrative Fund: $36.63/$1.11
0
0Laborer: Group 4
3
Adan Rodriguez
S
D 0
0
00000
8.00 8.008.00 8.00 0 42.7632.00
0.00
0.00
0.000.00
107.83 27.92 0.00
14.30
420.16 1009.87
622208897
0.00
160.71
1)
2)
3)O 0 0 0 1.00 0 0 0 1.00 61.71 0.00
1430.03
14757200
Other Deduction Detail: Dues: 160.71
112.62
1472.06
Indio, CA 92201
49634 Wayne St.
Fringe Detail: Vacation: $82.79/$4.87, Health & Welfare: $126.99/$7.47, Pension: $142.80/$8.40, Training Fund: $11.73/$0.69, Administrative Fund: $18.87/$1.11
0
0Laborer: Group 4
2
Isaac Ruiz
S
D 0
0
00000
8.00 8.0000 0 44.7616.00
0.00
0.00
0.000.00
122.57 33.19 0.00
14.72
700.01 772.05
559676643
0.00
416.91
1)
2)
3)O 0 0 0 1.00 0 0 0 1.00 64.71 0.00
780.87
147206
Other Deduction Detail: Dues: 115.17, Garnishment: 301.74
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
2.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/17/2019 2016-08/2016-08
11 12 13 14 15 16 17
Medicare
MON TUE WED THU FRI SAT SUN
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
Jacobsson Engineering Construction (a sub of Urban Habitat)
11th
Payroll Supervisor
January 8th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019November17th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Local Tax, State Tax, Dues, Garnishment
43.03
2967.49
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $29.22/$4.87, Health & Welfare: $44.82/$7.47, Pension: $50.40/$8.40, Training Fund: $4.14/$0.69, Administrative Fund: $6.66/$1.11
2.00
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
0 02.00 2.00 0 46.016.00
0.00
0.00
0.000.00
443.64 178.72 0.00
0.00
938.11 2029.38
000002817
0.00
272.72
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
276.06
14828533
Other Deduction Detail: Dues: 272.72
32.73
427.92
El Centro, CA 92243
1765 Vine St.
Fringe Detail: Vacation/ Holiday: $28.40/$3.55, Health & Welfare: $92.80/$11.60, Pension: $77.20/$9.65, Training Fund: $8.40/$1.05, Administrative Fund: $15.28/$1.91
0
0Operating Engineer:
Group 8
4
Andrew Gonzalez
S
D 0
0
00000
0 8.0000 0 53.498.00
0.00
0.00
0.000.00
0.00 0.00 0.00
4.28
65.41 362.51
565235522
0.00
28.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
427.92
8185667
Other Deduction Detail: Dues: 28.40
Male Hispanic American
83.12
1086.48
La Quinta, CA 92253
52545 Avenida Vallejo
Fringe Detail: Vacation/ Holiday: $95.48/$3.41, Health & Welfare: $146.44/$5.23, Pension: $47.04/$1.68, Training Fund: $19.32/$0.69, Administrative Fund: $31.08/$1.11
0
0Laborer/Group 1
4
Jeremy Harrison
S
D 0
0
00000
8.00 8.004.00 8.00 0 30.1828.00
0.00
0.00
0.000.00
79.11 35.50 0.00
10.86
331.35 755.13
614201662
0.00
122.76
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
845.04
Apprentice Level 4 14828540
Other Deduction Detail: Dues: 122.76
Male Caucasian
163.68
2139.60
Murrieta, CA 92562
23770 Fieldcrest Lane
Fringe Detail: Vacation/ Holiday: $142.00/$3.55, Health & Welfare: $464.00/$11.60, Pension: $386.00/$9.65, Training Fund: $42.00/$1.05, Administrative Fund: $76.40/$1.91
8.00
0Operating Engineer:
Group 8
9
Scott Helm
S
D 0
0
00000
8.00 8.008.00 8.00 0 53.4940.00
0.00
0.00
0.000.00
215.07 129.66 0.00
21.40
671.81 1467.79
553530862
0.00
142.00
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
2139.60
14828541
Other Deduction Detail: Dues: 142.00
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
3.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/24/2019 2016-08/2016-08
18 19 20 21 22 23 24
Medicare
MON TUE WED THU FRI SAT SUN
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.
105.35
1377.16
Palm Springs, CA 92262
2230 N. Whitewater Club Drive
Fringe Detail: Vacation/ Holiday: $58.44/$4.87, Health & Welfare: $89.64/$7.47, Pension: $100.80/$8.40, Training Fund: $8.28/$0.69, Administrative Fund: $13.32/$1.11
8.00
0Laborer: Group 3
3
ROBERTO MARTINEZRECENDEZ
S
D 0
0
00000
0 04.00 0 0 41.2112.00
0.00
0.00
0.000.00
101.49 24.91 0.00
13.77
372.52 1004.64
616314224
0.00
127.00
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
494.52
1482854
Other Deduction Detail: Dues: 127.00
124.42
1626.40
Coachella, CA 92236
84332 Capitola Ave.
Fringe Detail: Vacation: $194.80/$4.87, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Training Fund: $27.60/$0.69, Administrative Fund: $44.40/$1.11
8.00
0Laborer: Group 2
8
Francisco Rios
S
D 0
0
00000
8.00 8.008.00 8.00 0 40.6640.00
0.00
0.00
0.000.00
73.24 25.90 0.00
16.26
434.62 1191.78
604194135
0.00
194.80
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1626.40
14828567
Other Deduction Detail: Dues: 194.80
149.33
1952.18
Moreno Valley, CA 92557
12379 Kitching St.
Fringe Detail: Vacation: $206.975/$4.87, Health & Welfare: $317.475/$7.47, Pension: $357.00/$8.40, Training Fund: $29.325/$0.69, Administrative Fund: $47.175/$1.11
8.00
0Laborer: Group 4
3
Adan Rodriguez
S
D 0
0
00000
8.00 8.008.00 8.00 0 42.7640.00
0.00
0.00
0.000.00
170.49 64.05 0.00
19.52
610.37 1341.81
622208897
0.00
206.98
1)
2)
3)O 1.00 0 1.00 0 0.50 0 0 2.50 64.71 0.00
1872.17
14828568
Other Deduction Detail: Dues: 206.98
137.54
1797.95
Indio, CA 92201
49634 Wayne St.
Fringe Detail: Vacation: $185.06/$4.87, Health & Welfare: $283.86/$7.47, Pension: $319.20/$8.40, Training Fund: $26.22/$0.69, Administrative Fund: $42.18/$1.11
8.00
0Laborer: Group 4
2
Isaac Ruiz
S
D 0
0
00000
8.00 8.006.00 8.00 0 44.7638.00
0.00
0.00
0.000.00
161.68 54.70 0.00
17.98
925.28 872.67
559676643
0.00
553.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1700.88
8201371
Other Deduction Detail: Dues: 192.37, Garnishment: 361.01
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
3.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/24/2019 2016-08/2016-08
18 19 20 21 22 23 24
Medicare
MON TUE WED THU FRI SAT SUN
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 #3
Jacobsson Engineering Construction (a sub of Urban Habitat)
18th
Payroll Supervisor
January 10th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019November24th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Local Tax, State Tax, Dues, Garnishment
24.70
1703.51
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $19.48/$4.87, Health & Welfare: $29.88/$7.47, Pension: $33.60/$8.40, Training Fund: $2.76/$0.69, Administrative Fund: $4.44/$1.11
2.00
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
0 002.00 0 46.014.00
0.00
0.00
0.000.00
169.73 59.04 0.00
0.00
414.18 1289.33
000002817
0.00
160.71
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
184.04
14851338
Other Deduction Detail: Dues: 160.71
55.41
724.32
La Quinta, CA 92253
52545 Avenida Vallejo
Fringe Detail: Vacation/ Holiday: $81.84/$3.41, Health & Welfare: $125.52/$5.23, Pension: $40.32/$1.68, Training Fund: $16.56/$0.69, Administrative Fund: $26.64/$1.11
8.00
0Laborer/Group 1
4
Jeremy Harrison
S
D 0
0
00000
0 08.00 8.00 0 30.1824.00
0.00
0.00
0.000.00
35.65 8.33 0.00
7.24
188.47 535.85
614201662
0.00
81.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
724.32
Apprentice Level 4 14851344
Other Deduction Detail: Dues: 81.84
Male Caucasian
98.21
1283.76
Murrieta, CA 92562
23770 Fieldcrest Lane
Fringe Detail: Vacation/ Holiday: $85.20/$3.55, Health & Welfare: $278.40/$11.60, Pension: $231.60/$9.65, Training Fund: $25.20/$1.05, Administrative Fund: $45.84/$1.91
8.00
0Operating Engineer:
Group 8
9
Scott Helm
S
D 0
0
00000
0 08.00 8.00 0 53.4924.00
0.00
0.00
0.000.00
54.32 42.10 0.00
12.84
292.67 991.09
553530862
0.00
85.20
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1283.76
14851345
Other Deduction Detail: Dues: 85.20
104.22
1362.23
Indio, CA 92201
81-305 Avenida Coyote
Fringe Detail: Vacation/ Holiday: $28.40/$3.55, Health & Welfare: $92.80/$11.60, Pension: $77.20/$9.65, Training Fund: $8.40/$1.05, Administrative Fund: $15.28/$1.91
0
0Operating Engineer:
Group 8
5
Benjamin Ortiz
S
D 0
0
00000
0 08.00 0 0 53.498.00
0.00
0.00
0.000.00
128.78 36.52 0.00
13.62
371.89 990.34
552111682
0.00
88.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
427.92
14851365
Other Deduction Detail: Dues: 88.75
Male Hispanic American
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
4.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/01/2019 2016-08/2016-08
25 26 27 28 29 30 1
Medicare
MON TUE WED THU FRI SAT SUN
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.
48.38
632.40
Desert Hot Springs, CA 92240
13860 West Drive
Fringe Detail: Vacation/ Holiday: $54.56/$3.41, Health & Welfare: $83.68/$5.23, Pension: $26.88/$1.68, Training Fund: $11.04/$0.69, Administrative Fund: $17.76/$1.11
0
0Laborer/Group 1
4
Johnny Ramirez
S
D 0
0
00000
0 08.00 8.00 0 26.3516.00
0.00
0.00
0.000.00
8.24 0.00 0.00
6.32
144.78 487.62
605624404
0.00
81.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
421.60
Apprentice Level 3 14851371
Other Deduction Detail: Dues: 81.84
Male Hispanic American
76.88
1005.12
Coachella, CA 92236
84332 Capitola Ave.
Fringe Detail: Vacation: $116.88/$4.87, Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Training Fund: $16.56/$0.69, Administrative Fund: $26.64/$1.11
8.00
0Laborer: Group 2
8
Francisco Rios
S
D 0
0
00000
0 08.00 8.00 0 40.6624.00
0.00
0.00
0.000.00
5.13 0.00 0.00
10.05
211.38 793.74
604194135
0.00
119.32
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
975.84
14851372
Other Deduction Detail: Dues: 119.32
89.61
1171.31
Moreno Valley, CA 92557
12379 Kitching St.
Fringe Detail: Vacation: $124.185/$4.87, Health & Welfare: $190.485/$7.47, Pension: $214.20/$8.40, Training Fund: $17.595/$0.69, Administrative Fund: $28.305/$1.11
8.00
0Laborer: Group 4
3
Adan Rodriguez
S
D 0
0
00000
0 08.00 8.00 0 44.7624.00
0.00
0.00
0.000.00
76.79 15.85 0.00
11.71
318.15 853.16
622208897
0.00
124.19
1)
2)
3)O 0.50 0.50 0.50 0 0 0 0 1.50 64.71 0.00
1171.30
14851373
Other Deduction Detail: Dues: 124.19
82.18
1074.24
Indio, CA 92201
49634 Wayne St.
Fringe Detail: Vacation: $116.88/$4.87, Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Training Fund: $16.56/$0.69, Administrative Fund: $26.64/$1.11
8.00
0Laborer: Group 4
2
Isaac Ruiz
S
D 0
0
00000
0 08.00 8.00 0 44.7624.00
0.00
0.00
0.000.00
74.83 14.07 0.00
10.74
538.92 535.32
559676643
0.00
357.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1074.24
8211313
Other Deduction Detail: Dues: 116.88, Garnishment: 240.22
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
4.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/01/2019 2016-08/2016-08
25 26 27 28 29 30 1
Medicare
MON TUE WED THU FRI SAT SUN
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 #4
Jacobsson Engineering Construction (a sub of Urban Habitat)
25th
Payroll Supervisor
January 10th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019November1st
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Local Tax, State Tax, Dues, Garnishment
29.81
2055.87
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $34.09/$4.87, Health & Welfare: $52.29/$7.47, Pension: $58.80/$8.40, Training Fund: $4.83/$0.69, Administrative Fund: $7.77/$1.11
2.00
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
2.00 2.001.00 0 0 46.017.00
0.00
0.00
0.000.00
243.08 88.11 0.00
0.00
565.54 1490.33
000002817
0.00
204.54
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
322.07
14925014
Other Deduction Detail: Dues: 204.54
98.22
1283.76
Yucca Valley, CA 92284
1262 Cherokee Trail
Fringe Detail: Vacation/ Holiday: $56.80/$3.55, Health & Welfare: $185.60/$11.60, Pension: $154.40/$9.65, Training Fund: $16.80/$1.05, Administrative Fund: $30.56/$1.91
0
0Operating Engineer:
Group 8
7
Matthew Cossey
S
D 0
0
00000
0 8.0008.00 0 53.4916.00
0.00
0.00
0.000.00
51.51 10.81 0.00
12.84
258.58 1025.18
564931790
0.00
85.20
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
855.84
14925015
Other Deduction Detail: Dues: 85.20
Male Caucasian
73.88
965.76
La Quinta, CA 92253
52545 Avenida Vallejo
Fringe Detail: Vacation/ Holiday: $27.28/$3.41, Health & Welfare: $41.84/$5.23, Pension: $13.44/$1.68, Training Fund: $5.52/$0.69, Administrative Fund: $8.88/$1.11
8.00
0Laborer/Group 1
4
Jeremy Harrison
S
D 0
0
00000
0 000 0 30.188.00
0.00
0.00
0.000.00
64.62 24.88 0.00
9.66
282.16 683.60
614201662
0.00
109.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
241.44
Apprentice Level 4 14925022
Other Deduction Detail: Dues: 109.12
Male Caucasian
50.63
661.68
Thermal, CA 92274
2828 Bach Avenue
Fringe Detail: Vacation/ Holiday: $9.74/$4.87, Health & Welfare: $14.94/$7.47, Pension: $16.80/$8.40, Training Fund: $1.38/$0.69, Administrative Fund: $2.22/$1.11
0
0Laborer: Group 4
4
Jesus Oseguera
S
D 0
0
00000
0 2.0000 0 44.762.00
0.00
0.00
0.000.00
11.17 0.00 0.00
6.62
122.18 539.50
624386133
0.00
53.76
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
89.52
14925044
Other Deduction Detail: Dues: 53.76
Male Hispanic American
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
5.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/08/2019 2016-08/2016-08
2 3 4 5 6 7 8
Medicare
MON TUE WED THU FRI SAT SUN
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.
95.50
1248.32
Coachella, CA 92236
84332 Capitola Ave.
Fringe Detail: Vacation: $77.92/$4.87, Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Training Fund: $11.04/$0.69, Administrative Fund: $17.76/$1.11
0
0Laborer: Group 2
8
Francisco Rios
S
D 0
0
00000
8.00 8.0000 0 40.6616.00
0.00
0.00
0.000.00
29.45 4.26 0.00
12.48
273.37 974.95
604194135
0.00
131.68
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
650.56
14925049
Other Deduction Detail: Dues: 131.68
119.47
1561.74
Moreno Valley, CA 92557
12379 Kitching St.
Fringe Detail: Vacation: $165.58/$4.87, Health & Welfare: $253.98/$7.47, Pension: $285.60/$8.40, Training Fund: $23.46/$0.69, Administrative Fund: $37.74/$1.11
8.00
0Laborer: Group 4
3
Adan Rodriguez
S
D 0
0
00000
8.00 8.008.00 0 0 44.7632.00
0.00
0.00
0.000.00
123.64 36.61 0.00
15.62
460.92 1100.82
622208897
0.00
165.58
1)
2)
3)O 1.00 0 0 1.00 0 0 0 2.00 64.71 0.00
1561.74
14925050
Other Deduction Detail: Dues: 165.58
109.57
1432.32
Indio, CA 92201
49634 Wayne St.
Fringe Detail: Vacation: $155.84/$4.87, Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Training Fund: $22.08/$0.69, Administrative Fund: $35.52/$1.11
8.00
0Laborer: Group 4
2
Isaac Ruiz
S
D 0
0
00000
8.00 8.008.00 0 0 44.7632.00
0.00
0.00
0.000.00
117.80 30.56 0.00
14.32
722.61 709.71
559676643
0.00
450.36
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1432.32
8247877
Other Deduction Detail: Dues: 155.84, Garnishment: 294.52
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
5.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/08/2019 2016-08/2016-08
2 3 4 5 6 7 8
Medicare
MON TUE WED THU FRI SAT SUN
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 #5
Jacobsson Engineering Construction (a sub of Urban Habitat)
2nd
Payroll Supervisor
January 11th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019December8th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Local Tax, State Tax, Dues, Garnishment
53.20
695.37
Niland, CA 92257
2 Crystal Lane
Fringe Detail: Vacation/ Holiday: $17.75/$3.55, Health & Welfare: $58.00/$11.60, Pension: $48.25/$9.65, Training Fund: $5.25/$1.05, Administrative Fund: $9.55/$1.91
5.00
0Operating Engineer:
Group 8
3
Edgar AlvarezRomero
S
D 0
0
00000
0 000 0 53.495.00
0.00
0.00
0.000.00
22.61 0.47 0.00
6.95
129.38 565.99
604428416
0.00
46.15
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.45
14997909
Other Deduction Detail: Dues: 46.15
Male Hispanic American
36.34
2506.25
Indio, CA 92203
37843 Caprice Dr.
Fringe Detail: Vacation/ Holiday: $19.48/$4.87, Health & Welfare: $29.88/$7.47, Pension: $33.60/$8.40, Training Fund: $2.76/$0.69, Administrative Fund: $4.44/$1.11
2.00
0Laborer: Group 4
0
Ramiro Corona
S
D 0
0
00000
0 02.00 0 0 46.014.00
0.00
0.00
0.000.00
342.16 131.53 0.00
0.00
753.53 1752.72
000002817
0.00
243.50
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
184.04
14997919
Other Deduction Detail: Dues: 243.50
140.97
1842.71
Moreno Valley, CA 92557
12379 Kitching St.
Fringe Detail: Vacation: $82.79/$4.87, Health & Welfare: $126.99/$7.47, Pension: $142.80/$8.40, Training Fund: $11.73/$0.69, Administrative Fund: $18.87/$1.11
8.00
0Laborer: Group 4
3
Adan Rodriguez
S
D 0
0
00000
0 08.00 0 0 44.7616.00
0.00
0.00
0.000.00
157.36 55.15 0.00
18.43
569.15 1273.56
622208897
0.00
197.24
1)
2)
3)O 0.50 0.50 0 0 0 0 0 1.00 64.71 0.00
780.87
14997956
Other Deduction Detail: Dues: 197.24
134.94
1763.92
Indio, CA 92201
49634 Wayne St.
Fringe Detail: Vacation: $77.92/$4.87, Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Training Fund: $11.04/$0.69, Administrative Fund: $17.76/$1.11
8.00
0Laborer: Group 4
2
Isaac Ruiz
S
D 0
0
00000
0 08.00 0 0 44.7616.00
0.00
0.00
0.000.00
157.59 52.45 0.00
17.64
889.02 874.90
559676643
0.00
526.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
716.16
8285625
Other Deduction Detail: Dues: 171.57, Garnishment: 354.83
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 DTJacobsson Engineering Construction
72310 Varner Rd
Thousand Palms, CA 92276
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/15/2019 2016-08/2016-08
9 10 11 12 13 14 15
Medicare
MON TUE WED THU FRI SAT SUN
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
Jacobsson Engineering Construction (a sub of Urban Habitat)
9th
Payroll Supervisor
January 11th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019December15th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Local Tax, State Tax, Dues, Garnishment
Contract #2016-08, ,Payroll #7Payroll #7 - No Work Performed
Jacobsson Engineering Construction (a sub of Urban Habitat)
16th
Payroll Supervisor
January 11th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019December22nd
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
Contract #2016-08, ,Payroll #8Payroll #8 - No Work Performed
Jacobsson Engineering Construction (a sub of Urban Habitat)
23rd
Payroll Supervisor
January 11th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20192019December29th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
Contract #2016-08, ,Payroll #9Payroll #9 - No Work Performed
Jacobsson Engineering Construction (a sub of Urban Habitat)
30th
Payroll Supervisor
January 18th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2019 20202020December5th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
Contract #2016-08, Payroll #0Payroll #10 - No Work Performed
Jacobsson Engineering Construction (a sub of Urban Habitat)
6th
Payroll Supervisor
January 18th, 2020
Jacobsson Engineering Construction (a sub of Urban Habitat)
2020 20202020January12th
-
* 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 ElectronicallyArika Starkey, 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 ,
Arika Starkey
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS