2016-08 Sky Construction, Inc. Certified Payroll WE 2020.08.08PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-3471nst.)
NAME OF CONTRACTOR OR SUBCONTRACTOR F/� Wage CA-SC-UH
ADDRESS 7626 Rockaway Ave.
Sky Construction Det:
Yucca Valley, CA 92284
PAYROLL NO.
FOR WEEK ENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
1.2
08/08/2020
La Quinta SilverRock Park Venue
La Quinta SilverRock Resort
2016-08/2016-08
(1)
(2)
(3)
(4) DAY AND DATE
(5)
(6)
(7)
(8) * Other Deductions- 1) Local Tax 1
(9)
NAME, ADDRESS, AND
Identification Number
OF EMPLOYEE
0
iN
08
LL= n.
o w
z �S'�
WORK
CLASSIFICATION
TOTAL
HOURS
RAWITH-
TE
OF PAY
GROSS
AMOUNT
EARNED
DEDUCTIONS 2) Local Tax 2
3) Other Deductons
NET
WAGES
PAID
FOR WEEK/
Check No.
o
o SUN
MON
TUE
wED
THU
FRI
SAT
2
u,
1 3
1 4
1 5
1 6
1 7 1
8
FICA
HOLDING
TAX
SWH
Medicare
OTHER"
TOTAL
DEDUCTIONs
HOURS WORKED EACH DAY
Sex Race
Mario Crncic
Dperating Engineer:
D o
0
0
0
0
0
0
0.00
0.00 0.00
1023.80
1) 0.00
7626 Rockaway Ave.
Yucca Valley, CA 92284
2
roup 8
96.32
141.45
60.45
22.53
2) 0.00
3) 0.00
320.75
703.05
O o
0
0
0
0
0
0
0.00
0.00 0.0o
S 0
0
a.00
00
o
8.00
0
20.00
51.19 a0o
572517164
1 223.80
1306
Male Caucasian
Fringe Detail: Health & Welfare: $160.00/$8.00, Other: $12.20/$0.61, Pension: $188.UU/$8.40, Vacation/ Holidav: $128.60/$6.43, Annuity: $/5.UU/$3.1b, I raininq Fund: $35.00/$1.75
Paul Gruber
9791 1/2 Birmingham Ave
Riverside, CA 92509
2
earn r: Group 3
D 0
0
0
0
0
0
0
0.00
0.00 o.00
740.00
51.92
45.58
25.54
12.14
2) 0.00
3) 97.40
232.58
604.82
O o
0
0
0
0
0
0
0.00
0.00 0.00
S o
c
8.00
4.00
o
8.00
0
20.00
37.00 0.00
310828571
837.40
1309
Male Caucasian
Fringe Detail: Training Fund: $51.00/$2.55, Vacation/ Holiday: $97.40/$4.87, Health & Welfare: $176.60/$8.83, Pension: $168.00/$8.40, Administrative Fund: $12.20/$0.61, Annuity. $34.001$1.70
Other Deduction Detail: Vacation: 97.40
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 thatthe 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.
Date August 29th, 2020
1, Roberta Crncic Payroll Supervisor
(Name of Signatory Party) (Title)
under penalty of perjury, do hereby state:
(1) That I pay or supervise the payment of the persons employed by
Sky Construction (a sub of Urban Habitat) on the
(Contractor or Subcontractor)
La Quinta SilverRock Park Venue a Public Works Project commencing on the
(Building or Work)
2nd day of August , 2020 , and ending the 8th day of August 2020
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
Sky Construction (a sub of Urban Habitat)
(Contractor or Subcontractor)
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.
FICA, FWH, Medicare, State Tax, Vacation
(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:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
0 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.
(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.
(c) EXCEPTIONS
REMARKS
Contract#2016.08, Wage Decision #CA•SC-UH Mod 0 10/01 /1 9,Revised Payroll #1.2
NAME AND TITLE:
Roberta Crncic, Payroll Supervisor
SIGNATURE:
Signed Electronically
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.
U.S. G.P.O.: 1997519.861
ublic Works Certified Payroll Reporting Form
Certification under penalty of perjury.
"I, ROBERTA CRNCIC, the undersigned, am the PRESIDENT (position in business) with the authority to act for and on behalf of SKY CONSTRUCTION SERVICES, INC (name of business and/or contractor),
certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2020-08-08 are the originals or true, full, and correct copies of the
originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. i certify this on 2020-08-31."
Contractor Name: SKY CONSTRUCTION Contractor PWCR: 1000046770 License Type: CSLB License Number 962660
Address. 7626 ROCKAWAY AVE., YUCCA VALLEY, CA FEIN: 814976305 Contractor Email: RDERRINGTON@YAHOO.COM
92284
Insurance Number: WSA5056129
Awarding Body: THE CITY OF LA QUINTA DIR Project ID: 300347 Project Name: LA QUINTA SILVERROCK PARK VENUE
Contract With: URBAN HABITAT County: RIVERSIDE Location Description: LA QUINTA SILVERROCK RESORT
Payroll Number: 1 0
For Week Ending: 08/08/2020 ; is this a 'Statement of Non -Performance?'
Name, Address and
Social SecurityNumber of Worker
Number of
Withholding
Day
Deductions, Contributions, and Payments
Sun Mon Tue Wed Thu Fri Sat
Total
Hours
Hourly
Pay Rate
Gross Amount
Earned
Federal
Tax
FICA
State
Tax
SDI
Vac/
Holiday
Health
& Welf.
Ponsion
Net
Wage
Paid For
Week
Check
Number
MARIO CRNCIC
7626 ROCKAWAY AVE.
2
Date
Work
Classification
08/02 08/03 O8fO4 08/05 08106 08/07 08/08
This
Project
All
Projects
141.45
96.32
60.45
0.00
128.60
160.00
168.00
Hours Worked Each Day
YUCCA VALLEY
CA
92284
572517164
OPERATING
ENGINEER/GRO
UP 8
S
0.00
0.00
8.00
4.00
0.00
8.00
0.00
20.00
51.19
1,023.80
1,023.80
Training
Fund
Admin
Dues
hav!
Subs
Savings
Other
Total
Deduct
703.05
1306
i
0
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.00
109.73
320.75
D
0.00
a.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NOTE: ANNUITY:75.00,OTHER:12.20MEDICARE:22.53
i Name, Address and
Social SecurityNumber of Worker
Number of
Withholding
+
Day
Deductions, Contributions, and Payments
Sun Mon Too Wed Thu Fd Sat
Total
Hours
Hourly
Pay Rate
Gross Amount
Earned
Federal
Tax
FICA
State
Tax
SDI
Vac/
Holiday
Health
& Walf.
Pension
Net
Wage
Paid For
Week
Chock
Number
PAUL GRUBER
9791 1/2 BIRMINGHAM AVE
2
Date
Work
Classification
08/02 08/03 08104 08105 08106 08107 O8/OB
This
Project
All
Projects
45.58
51.92
25.54
0.00
97.40
176.60
168.00
Hours Worked Each Day
RIVERSIDE
CA
92509
i
310828571
TEAMSTER/GR
OUP 3
S
0.00
0.00
6.00
4.00
0.00
8.00
0.00
20.00
37.00
740.00
837.40
Training
Fund
Admin
Dues
Ttav!
Subs
Savings
Other
Total
Deduct
604.82
1309
i
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4.00
0.00
51.00
12.20
0,00
0.00
0.00
143.54
232.58
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0,00
0.00
NOTE: ANNUITY:34:OOMEDICARE:12.14,VACATION:97.40
i
i Public works certified Payroll Reporting Form 08/31/2020 - Page 1