2016-08 Sky Construction, Inc. Certified Payroll WE 2020.08.22PAYROLL
(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 WEEKENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
La Quinta SilverRock Park Venue
3.1
08/22/2020
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 `D
DEDUCTIONS 2) Local Tax 2
o SUN
MON
TUE
WE
THU
FRI
SAT
z
3) Other Deductions
NET
NAME, ADDRESS, AND
06
w = a
WORK
r
GROSS
WAGES
PAID
16
"�
17
18
19
20
21
22
WITH-
Identification Number
x
CLASSIFICATION
TOTAL
RATE
AMOUNT
HOLDING
TOTAL
FOR WEEK/
HOURS WORKED EACH DAY
OF EMPLOYEE
z w
HOURS
OF PAY
EARNED
FICA
TAX
SWrI
Medicare
OTHER"
DEDUCTIONS
Check No.
Sex Race
Mario Crncic
Ciperating Engineer:
D otD-00
0.00
0.00 0.00
358.33
1) 0.00
7626 Rockaway Ave.
1
roup 8
2) 0.00
0
Yucca Valley, CA 92284
O
J00
Jo
0.00
0.00 0.00
33.71
23.22
9.18
7 88
3) 0.00
73.99
284.34
S o
T00
51.19 0.00
572517164
358.33
1318
Male Caucasian
Fringe Detail: Health & Welfare: $56.00/$8.00, Pension: $58.80/$8.4U, Vacation/ Holiday: $4b.U1/$(5.43, Annuity: $26.2b/$3.1b, Iraining fund: $12.Z51$1.fb, Other: $4.2(/$0.61
Paul Gruber
9791 112 Birmingham Ave
Riverside, CA 92509
2
eamster: Group 3
D o
0
0
0
0
0
0
0.00
o.00 o.00
259,00
18.17
0.00
2.93
4.25
1) 0,00
2) 0.00
3) 34.09
59.44
233.65
O 0
o
c
o
0
0
0
0.00
0.00 o.m
S o
zoo
0
0
0
0
0
7.00
szoo 0.0o
310828571
293.09
1321
Male Caucasian
Fringe Detail: Training Fund: $17.85/$2.55, Vacation/ Holiday: $34.09/$4.87, Health & Welfare: $61.81/$8.83, Pension: $58.80/$8.40, Administrative Fund: $4.27/$0.61, Annuity: $11.90/$1.70
Other Deduction Detail: Vacation Holiday: 34.09
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
I, 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)
16th day of August , 2020 , and ending the 22nd 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
Q " 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 #CASC-UH Mod 010/01/19,Revised Payroll #3.1
NAME AND TITLE: SIGNATURE:
Roberta Cmcic, Payroll Supervisor Signed Electronically
THE 1MLLFUL 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 i"aviuii iiv}lut t'sy t-ui n7
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 2020-08-22 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: 3- 0 _ For Week Ending: 08/22/2020 is this a'Statement of Non -Performance?'
Name, Address and
Social Security Number 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.
Pension
Net
Wage
Paid For
Week
Check
Number
MARIO CRNCIC
7626 ROCKAWAY AVE.
YUCCA
1
Date
Work
Classification
08116 08117 08/1R 08119 08120 08/21 08122
This
Project
All
Projects
23.22
33.71
9.18
0.00
4.5,01
56.00
58.80
Hours Worked Each Day
VALLEY
CA
92284
572517164
OPERATING
ENGINEER/GRO
UP 8
S
0.00
7,00
0.00
0.00
0.00
0.00
0.00
7.00
51.19
358.33
358.33
Training
Fund
Admin
Dues
Trav/
Subs
Savings
Other
Total
Deduct
284.34
1318
p
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
91.25
0.00
0.00
1 0.00
0.00
38.40
73.99
D
70.00F
00
0.00
0.00
0.00
0.00
0.00
0,00
0.00
NOTE: ANNUITY:26.25,OTHER:4.27MEDICARE:7.88
Name, Address and
Social Security Number 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.
Pension
Net
Wage
Paid For
Week
Check
Number
PAUL GRUBER
9791 1/2 BIRMINGHAM AVE
RIVERSIDE
2
Date
Work
Classification
08/16 08/17 08/18 08l19 08l20 08121 08l22
This
Proect
I
All
Proects
1
0.00
18.17
2,93
0.00
34.09
61.81
58.80
Hours Worked Each Day
CA
92509
310828671
TEAMSTERlGR
OUP 3
5
0.00
7.00
0.00
0.00
0.00
0.00
0.00
7.00
37.00
259.00
293.09
Training
Fund
Admin
Dues
Trav/
Subs
Savings
Other
Total
Deduct
233.65
1321
p
0.00
0.00ro
.00
o.00
o.00
0.00
0.00
o.00
o.00
17.85
4.27
0.00
0.00
0.00
16.15
59.44
D
0.00
0.00.00
0.00
0.00
0.00
0.00
p,QO
O.OU
NOTE: ANNUITY: 11.90MEDICARE:4,25
Public works certified Payroll Reporting Form 08/31/2020 - Page 1