Team_West_Contracting_sub_of_Urban_Habitat_13.0_5-17-2049.33
2013.60
pomona, CA 91768
1373 ballerina pl
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $142.40/$8.90, Vacation/ Holiday: $77.92/$4.87, Training Fund: $11.04/$0.69, Other: $9.76/$0.61
0
0Laborer: Group 3
3
Jose Figueroa
S
D 0
0
00000
8.00 008.00 0 19.3616.00
0.00
21.85
0.000.00
230.72 81.52 124.84
0.00
591.24 1422.36
609725690
0.00
104.83
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
659.36
8667
Other Deduction Detail: Vacation Holiday: 104.83
Male Multiple Races
55.79
2276.98
San Bernardino, CA 92410
494 S. Mary St Sp 18
Fringe Detail: Health & Welfare: $119.52/$7.47, Vacation/ Holiday: $77.92/$4.87, Training Fund: $11.04/$0.69, Pension: $142.40/$8.90, Other: $9.76/$0.61
0
0Laborer: Group 3
3
Victor M. Gomez
S
D 0
0
00000
7.00 007.00 0 19.3614.00
0.00
21.85
0.000.00
234.09 89.28 141.17
0.00
625.16 1651.82
624283747
0.00
104.83
1)
2)
3)O 0 0 1.00 1.00 0 0 0 2.00 46.03 21.85
712.70
8669
Other Deduction Detail: Vacation Holiday: 104.83
Subcontinent Asian
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 DTTeam West Contracting
2733 Vista Ave
Bloomington, CA 92316
13.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort05/17/2020 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 #13, Contractor
License # 934352, Workers Compensation Policy # WCZ9146094028
Team West Contracting (a sub of Urban Habitat)
11th
Payroll Clerk
June 15th, 2020
Team West Contracting (a sub of Urban Habitat)
2020 2020MayMay17th
-
* 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 ElectronicallyAmanda Bruce, Payroll Clerk
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 ,
Amanda Bruce
(Contractor or Subcontractor)
La Quinta SilverRock Park Venue
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Vacation/Holiday