2016-08 Sky Construction, Inc. Certified Payroll WE 2020.08.15PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
NAME OF CONTRACTOR OR SUBCONTRACTOR Q Wage CA-SC-U H
ADDRESS 7626 Rockaway Ave.
Det:
Yucca Valley, CA 92284
Sky Construction
PAYROLL NO,
FOR WEEK ENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
La Quinta SilverRock Park Venue
2.1
08/15/2020
2016-08/2016-08
La Quinta SilverRock Resort
(1)
(2)
(3)
(4) DAY AND DATE
(5)
(6)
(7)
(8) * Other Deductions- 1) Local Tax 1
(9)
0 w
DEDUCTIONS 2) Local Tax 2
o
o SUN
MON
TUE
WED
THU
FRI
SAT
z
3) Other Deductions
NET
NAME, ADDRESS. AND
05
= a
WORK
GROSS
WAGES
PAID
9
"
10
11
12
13
14
15
Identification Number
O€w
CLASSIFICATION
TOTAL
RATE
AMOUNT
HOLDING
TOTAL
FORWEEK/
HOURS WORKED EACH DAY
OF EMPLOYEE
z 5'�
HOURS
OF PAY
EARNED
FICA
Tp,x
SWH
Medicare
OTHER*
DEDUCTIONS
Check No.
Sex Race
Mario Crncic
Operating Engineer:
D o
0
0
0
0
0
0
0.00
o.00 o.00X
1) 0.00
7626 Rockaway Ave.
1
roup 8
2) 0.00
o
0
0
0
Yucca Valley, CA 92284
O
0
0
0
0.00
0.00 0.00154.12
316.41
147.84
36.04
3) 0.00
654.41
983.67
T
0
8.00
e.00
8.00
8.00
0
32.00
51.19 0.00
572517164
1312
Male Caucasian
Fringe Detail: Health & Welfare: $256.00/$8.00. Vacation/ Holiday: $2U5.76/$6.43, Pension: $268.80/$8.40, Annuity: $120.00/$3.1b, -I ralninq Fund: $56.00/$1.75, Other: $19.52/$0.61
Paul Gruber
9791 1/2 Birmingham Ave
Riverside, CA 92509
2
eamster: Group 3
o
0
0
0
o
0
0,00
o.00 o.o0X1184.00
105.88
72.54
19.43
1) 0.00
2) 0.00436,76
3) 155.84
903.08
tDo
0
0
0
o
c
o
0.00
0.00 0.0083.07
o
e.00
a.00
s.00
a.ao
0
32.00
a7.ao o.ao
310828571
1315
Male Caucasian
Fringe Detail: Training Fund: $81.60/$2.55, Vacation/ Holiday: $155.84/$4.87, Health & Welfare: $282.56/$8.83, Pension: $268.80/$8.40, Administrative Fund: $19.52/$0.61, Annuity: $54.40/$1.70
Other Deduction Detail: Vacation Holiday: 155.84
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.
Date August 29th, 2020
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
1, Roberta Crncic Payroll Supervisor Each laborer or mechanic listed in the above referenced payroll has been paid, as
(Name of Signatory Party) (Title) indicated on the payroll, an amount not less than the sum of the applicable basic
under penalty of perjury, do hereby state: hourly wage rate plus the amount of the required fringe benefits as listed in the
(1) That I pay or supervise the payment of the persons employed by contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
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)
9th day of August 2020 , and ending the 15th 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 Holiday
(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
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.
REMARKS
Contract #2016-08, Wage Decision #CA-SC-UH Mod 010/01/19,Revised Payroll #2.1
NAME AND TITLE: SIGNATURE:
Roberta Cmcic, Payroll Supervisor 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.: 1997 619.961
Public Works Certified Payroll Reporting Form
Certification under penalty of perjury:
1, 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 2020-08-15 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. 1 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: 2- 0 For Week Ending: 08/15/2020 1" Is this a'Statement of Non -Performance?'
Name, Address and Number of Day Deductions, Contributions, and Payments
Social SecurityNumber of Worker Withholding Sun Mon Tue Wed Thu Fri Sat Gross Amount Federal State Vacl Health
Earned Tax FICA Tax SDI Holida & Welf. Pension Net
1 Date y
i MARtO CRNCiC Total Hourly Wage Chock
j Work 08/09 08I10 08/11 08/12 08/13 08/14 08115 Hours Pay Rate Thts Aii 316.41 154.12 147.84 0.00 205.76 256.00 268.80 Paid For Number
7626 ROCKAWAY AVE. Week
i Classification Hours Worked Each Day Project Projects
i YUCCA VALLEY
OPERATING
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
51.19
1,638.08
1,638.08
Fund
TraviDues
Total
983.67
1312
CA
ENGINEER/GRO
Training
Admin
Subs
Subs
Savings
Other
Deduct
p
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
UP 8
56.00
0.00
0.00
0.00
0.00
175.56
654.41
92284
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
572517164
NOTE: ANNUITY: 120.00,OTHER:19.52MEDICARE:36.04
i
Name, Address and
Number of
Day
Deductions, Contributions, and Payments
Sun Mon Tue Wed Thu Fri Sat
Gross Amount
Federal
State
Vac/
Health
Social SecurityNumber of Worker
Withholding
Total
Hourly
Earned
Tax
FICA
Tax
SDI
lolida y
& Wolf.
Pension
Net
Wage
2
Date
PAULGRUBER
Chock
Work
O8/09 08110 08/11 08/12 08113 08114 08115
This
All
105.88
83.07
72.54
0.00
155.84
282.56
268.8D
Hours
Pay Rate
Paid For
Number
9791 1/2 BIRMINGHAM AVE
Clossification
Project
projects
Week
Hours Worked Each Day
RIVERSIDE
TEAMSTERIGR
5
0.00
0.00
B.00
8.00
8.00
8.00
0.00
32.00
37.00
1,184.00
1,339.84
Fund
Trav/
Total
903.06
1315
CA
OUP 3
Training
Admin
Dues
Subs
Savings
Other
Deduct
0
0.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
0.00
81.60
19.52
0.00
0.00
0.00
73.83
436.76
92509
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
310828571
NOTE: ANNUITY:54.40MEDICARE:19.43
Public works Certified Payroll Reporting Form 08/31/202D - Page 1