2016-08 Urban Habitat Certified Payroll97.15
1458.58
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 35.4340.00
0.00
0.00
0.000.00
90.00 29.63 22.72
0.00
255.17 1203.41
270717343
0.00
15.67
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1417.20
DirectDeposit4212
Other Deduction Detail: SDI: 15.67
Male Caucasian
95.35
1538.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $394.80/$9.87, Pension: $394.80/$9.87, Vacation: $193.60/$4.84, Training Fund: $60.00/$1.50, Annuity: $10.00/$0.25, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 38.4540.00
0.00
0.00
0.000.00
130.00 45.26 22.30
0.00
308.29 1229.71
565931366
0.00
15.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1538.00
DirectDeposit
Other Deduction Detail: SDI: 15.38
Male Caucasian
89.62
1445.44
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $7.47/$7.47, Pension: $8.40/$8.40, Annuity: $0.50/$0.50, Vacation: $4.87/$4.87, Training Fund: $0.69/$0.69, Contract Compliance: $0.30/$0.30, Administrative Fund: $0.06/$0.06, Indust.
Stab.Fund: $0.12/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
0
00000
0 01.00 0 0 33.431.00
0.00
0.00
0.000.00
90.00 29.63 20.96
0.00
244.67 1200.77
604137146
0.00
14.46
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
33.43
DirectDeposit
Other Deduction Detail: SDI: 14.46
Male
82.91
1337.20
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 33.4340.00
0.00
0.00
0.000.00
126.00 34.23 19.38
0.00
275.90 1061.30
559657836
0.00
13.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1337.20
DirectDeposit
Other Deduction Detail: SDI: 13.38
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
1.2 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/19/2019 2016-08/2016-08
13 14 15 16 17 18 19
Medicare
SUN MON TUE WED THU FRI SAT
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 #1.2,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
13th
President
November 18th,
2019
Urban Habitat
2019 20192019October19th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI
95.36
1538.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $394.80/$9.87, Pension: $394.80/$9.87, Vacation: $193.60/$4.84, Training Fund: $60.00/$1.50, Annuity: $10.00/$0.25, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 38.4540.00
0.00
0.00
0.000.00
130.00 45.26 22.30
0.00
308.30 1229.70
565931366
0.00
15.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1538.00
DirectDeposit4215
Other Deduction Detail: SDI: 15.38
Male Caucasian
38.45
620.17
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Health & Welfare: $90.577/$2.45, Pension: $36.97/$1.00, Vacation: $38.079/$1.03, Annuity: $9.242/$0.25
0
0Landscape Irr. Tender
5
Pedro J. Clemente
S
D 0
8.00
00000
5.92 8.007.78 6.77 0 15.3036.47
0.00
0.00
0.000.00
0.00 0.00 9.00
0.00
53.65 566.52
657090571
0.00
6.20
1)
2)
3)O 0 0 0 0.20 0.12 0.18 0 0.50 22.96 0.00
569.47
DirectDeposit
Other Deduction Detail: SDI: 6.20
Male
44.18
712.60
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $20.041/$2.45, Pension: $8.18/$1.00, Annuity: $2.045/$0.25, Vacation: $8.425/$1.03
0
0Landscape Irr. Tender
5
Juan LopezMendez
S
D 0
8.00
00000
0 000 0 15.308.00
0.00
0.00
0.000.00
8.00 0.00 10.33
0.00
69.64 642.96
620099088
0.00
7.13
1)
2)
3)O 0 0 0 0 0 0.18 0 0.18 22.96 0.00
126.53
DirectDeposit
Other Deduction Detail: SDI: 7.13
Male
106.06
1710.77
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $121.761/$7.47, Pension: $136.92/$8.40, Annuity: $8.15/$0.50, Vacation: $79.381/$4.87, Training Fund: $11.247/$0.69, Contract Compliance: $4.89/$0.30, Administrative Fund: $0.978/$0.06,
Indust. Stab.Fund: $1.956/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
8.00
00000
0 8.0000 0 33.4316.00
0.00
0.00
0.000.00
122.00 54.02 24.80
0.00
323.98 1386.79
604137146
0.00
17.10
1)
2)
3)O 0 0 0 0 0.12 0.18 0 0.30 52.94 0.00
550.76
DirectDeposit
Other Deduction Detail: SDI: 17.10
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
2.3 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/26/2019 2016-08/2016-08
20 21 22 23 24 25 26
Medicare
SUN MON TUE WED THU FRI SAT
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.
106.06
1710.77
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $206.184/$9.87, Pension: $206.184/$9.87, Vacation: $101.108/$4.84, Annuity: $5.223/$0.25, Training Fund: $31.335/$1.50, Contract Compliance: $6.267/$0.30, Administrative Fund: $1.
253/$0.06, Indust. Stab.Fund: $250.68/$12.00
0
0Landscape Oper. Eng
5
Felipe Lopez
S
D 0
0
00000
5.92 08.00 6.77 0 38.4520.69
0.00
0.00
0.000.00
122.00 54.02 24.80
0.00
323.98 1386.79
604137146
0.00
17.10
1)
2)
3)O 0 0 0 0.20 0 0 0 0.20 57.70 0.00
807.07
DirectDeposit
Other Deduction Detail: SDI: 17.10
Male
75.80
1222.60
Hemet, CA 92544
40400 Newport Rd.
Fringe Detail: Health & Welfare: $67.081/$7.47, Pension: $75.432/$8.40, Vacation: $43.733/$4.87, Annuity: $4.49/$0.50, Administrative Fund: $0.539/$0.06, Indust. Stab.Fund: $1.078/$0.12, Contract Compliance: $2.694/$0.30,
Training Fund: $6.196/$0.69
0
0Landscape Irrigation
Labor
1
Martin Mercado
S
D 0
4.50
00000
0 4.4800 0 33.438.98
0.00
0.00
0.000.00
102.00 55.82 17.73
0.00
263.57 959.03
621104173
0.00
12.22
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
300.20
DirectDeposit
Other Deduction Detail: SDI: 12.22
Male
82.91
1337.20
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 33.4340.00
0.00
0.00
0.000.00
126.00 34.23 19.39
0.00
275.90 1061.30
559657836
0.00
13.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1337.20
DirectDeposit
Other Deduction Detail: SDI: 13.37
Male
58.11
937.18
San Bernardino, CA 92410
2260 W Riato Ave. #44
Fringe Detail: Health & Welfare: $30.625/$2.45, Pension: $12.50/$1.00, Vacation: $12.875/$1.03, Annuity: $3.125/$0.25
0
0Landscape Irr. Tender
2
Sergio Ortiz
S
D 0
4.50
00000
0 8.0000 0 17.0012.50
0.00
0.00
0.000.00
81.00 27.37 13.58
0.00
189.43 747.75
612141562
0.00
9.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
212.50
DirectDeposit
Other Deduction Detail: SDI: 9.37
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
2.3 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/26/2019 2016-08/2016-08
20 21 22 23 24 25 26
Medicare
SUN MON TUE WED THU FRI SAT
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.
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
2.3 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort10/26/2019 2016-08/2016-08
20 21 22 23 24 25 26
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
78.24
1261.96
Indio, CA 92201
43551 Main St.
Fringe Detail: Health & Welfare: $20.041/$2.45, Pension: $8.18/$1.00, Vacation: $8.425/$1.03, Annuity: $2.045/$0.25
0
0Landscape Irr. Tender
0
Juan F. Zaragoza Ponce
S
D 0
8.00
00000
0 000 0 15.308.00
0.00
0.00
0.000.00
182.00 62.34 18.30
0.00
353.50 908.46
621839632
0.00
12.62
1)
2)
3)O 0 0 0 0 0 0.18 0 0.18 22.96 0.00
126.53
DirectDeposit
Other Deduction Detail: SDI: 12.62
Male
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 #2.3,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
20th
President
November 26th,
2019
Urban Habitat
2019 20192019October26th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI
93.41
1506.58
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Annuity: $12.00/$0.50, Vacation: $116.88/$4.87, Training Fund: $16.56/$0.69, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06,
Indust. Stab.Fund: $2.88/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
0
00000
8.00 08.00 8.00 0 35.4324.00
0.00
0.00
0.000.00
93.00 15.06 21.85
0.00
238.38 1268.20
270717343
0.00
15.06
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
850.32
61427
Other Deduction Detail: SDI: 15.06
Male Caucasian
93.41
1506.58
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Vacation: $77.92/$4.87, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust.
Stab.Fund: $1.92/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
0 8.0000 0 33.4316.00
0.00
0.00
0.000.00
93.00 15.06 21.85
0.00
238.38 1268.20
270717343
0.00
15.06
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
534.88
61427
Other Deduction Detail: SDI: 15.06
Male Caucasian
95.35
1538.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $394.80/$9.87, Pension: $394.80/$9.87, Vacation: $193.60/$4.84, Training Fund: $60.00/$1.50, Annuity: $10.00/$0.25, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 38.4540.00
0.00
0.00
0.000.00
130.00 45.26 22.30
0.00
308.29 1229.71
565931366
0.00
15.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1538.00
61424
Other Deduction Detail: SDI: 15.38
Male Caucasian
37.94
61460.00
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Health & Welfare: $98.00/$2.45, Pension: $40.00/$1.00, Vacation: $41.20/$1.03, Annuity: $10.00/$0.25
0
0Landscape Irr. Tender
5
Pedro J. Clemente
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 15.3040.00
0.00
0.00
0.000.00
0.00 0.00 8.87
0.00
52.93 61407.07
657090571
0.00
6.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
612.00
61460
Other Deduction Detail: SDI: 6.12
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
3.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/02/2019 2016-08/2016-08
27 28 29 30 31 1 2
Medicare
SUN MON TUE WED THU FRI SAT
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.
43.08
694.80
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $176.00/$4.40, Cooperation Comm.: $12.00/$0.30, Training Fund: $53.60/$1.34, Indust. Stab.Fund: $3.20/$0.08, Vacation: $50.40/$1.26, Pension: $170.40/$4.26, Annuity: $10.00/$0.25,
Administrative Fund: $2.40/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 17.3740.00
0.00
0.00
0.000.00
51.00 11.48 10.07
0.00
122.58 572.22
617157389
0.00
6.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
694.80
Apprentice Level 1 61432
Other Deduction Detail: SDI: 6.95
Male
47.27
762.39
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $39.20/$2.45, Pension: $16.00/$1.00, Annuity: $4.00/$0.25, Vacation: $16.48/$1.03
0
0Landscape Irr. Tender
5
Juan LopezMendez
S
D 0
8.00
00000
0 08.00 0 0 15.3016.00
0.00
0.00
0.000.00
13.00 0.00 11.06
0.00
78.95 683.44
620099088
0.00
7.62
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
244.80
61447
Other Deduction Detail: SDI: 7.62
Male
94.40
1522.58
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Vacation: $77.92/$4.87, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust.
Stab.Fund: $1.92/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
8.00
00000
0 8.0000 0 35.4316.00
0.00
0.00
0.000.00
96.00 33.52 22.07
0.00
261.22 1261.36
604137146
0.00
15.23
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
566.88
61433
Other Deduction Detail: SDI: 15.23
Male
94.40
1522.58
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $236.88/$9.87, Pension: $236.88/$9.87, Vacation: $116.16/$4.84, Annuity: $6.00/$0.25, Training Fund: $36.00/$1.50, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06,
Indust. Stab.Fund: $288.00/$12.00
0
0Landscape Oper. Eng
5
Felipe Lopez
S
D 0
0
00000
8.00 08.00 8.00 0 38.4524.00
0.00
0.00
0.000.00
96.00 33.52 22.07
0.00
261.22 1261.36
604137146
0.00
15.23
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
922.80
61433
Other Deduction Detail: SDI: 15.23
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
3.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/02/2019 2016-08/2016-08
27 28 29 30 31 1 2
Medicare
SUN MON TUE WED THU FRI SAT
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.
82.90
1337.20
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 33.4340.00
0.00
0.00
0.000.00
126.00 34.23 19.39
0.00
275.89 1061.31
559657836
0.00
13.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1337.20
61448
Other Deduction Detail: SDI: 13.37
Male
87.96
1418.70
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Vacation: $155.84/$4.87, Training Fund: $22.08/$0.69, Annuity: $16.00/$0.50, Contract Compliance: $9.60/$0.30, Administrative Fund: $1.92/$0.06,
Indust. Stab.Fund: $3.84/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
8.00
00000
0 8.008.00 8.00 0 33.4332.00
0.00
0.00
0.000.00
136.00 64.16 20.57
0.00
322.88 1095.82
622987861
0.00
14.19
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1069.76
61455
Other Deduction Detail: SDI: 14.19
Male
87.96
1418.70
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $78.96/$9.87, Annuity: $2.00/$0.25, Pension: $78.96/$9.87, Vacation: $38.72/$4.84, Training Fund: $12.00/$1.50, Indust. Stab.Fund: $0.96/$0.12, Administrative Fund: $0.48/$0.06, Contract
Compliance: $2.40/$0.30
0
0Landscape Oper. Eng
4
Miguel L. Sanchez
S
D 0
0
00000
8.00 000 0 38.458.00
0.00
0.00
0.000.00
136.00 64.16 20.57
0.00
322.88 1095.82
622987861
0.00
14.19
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
307.60
61455
Other Deduction Detail: SDI: 14.19
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
3.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/02/2019 2016-08/2016-08
27 28 29 30 31 1 2
Medicare
SUN MON TUE WED THU FRI SAT
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 #3.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
27th
President
November 18th,
2019
Urban Habitat
2019 20192019October2nd
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI
87.00
1403.20
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $246.51/$7.47, Pension: $277.20/$8.40, Annuity: $16.50/$0.50, Vacation: $160.71/$4.87, Training Fund: $22.77/$0.69, Contract Compliance: $9.90/$0.30, Administrative Fund: $1.98/$0.06,
Indust. Stab.Fund: $3.96/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
8.00 4.504.50 8.00 0 33.4333.00
0.00
0.00
0.000.00
95.00 28.60 20.35
0.00
244.99 1158.21
270717343
0.00
14.04
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1103.19
61476
Other Deduction Detail: SDI: 14.04
Male Caucasian
87.00
1403.20
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $52.29/$7.47, Pension: $58.80/$8.40, Annuity: $3.50/$0.50, Vacation: $34.09/$4.87, Training Fund: $4.83/$0.69, Contract Compliance: $2.10/$0.30, Administrative Fund: $0.42/$0.06, Indust.
Stab.Fund: $0.84/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
0
00000
0 3.503.50 0 0 35.437.00
0.00
0.00
0.000.00
95.00 28.60 20.35
0.00
244.99 1158.21
270717343
0.00
14.04
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
248.01
61476
Other Deduction Detail: SDI: 14.04
Male Caucasian
94.05
1516.86
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $325.71/$9.87, Pension: $325.71/$9.87, Vacation: $159.72/$4.84, Training Fund: $49.50/$1.50, Annuity: $8.25/$0.25, Contract Compliance: $9.90/$0.30, Administrative Fund: $1.98/$0.06,
Indust. Stab.Fund: $3.96/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 4.504.50 8.00 0 38.4533.00
0.00
0.00
0.000.00
128.00 43.40 22.00
0.00
302.62 1214.24
565931366
0.00
15.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1268.85
61473
Other Deduction Detail: SDI: 15.17
Male Caucasian
94.05
1516.86
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Indust. Stab.Fund: $0.84/$0.12, Vacation: $34.09/$4.87, Annuity: $3.50/$0.50, Training Fund: $4.83/$0.69, Health & Welfare: $52.29/$7.47, Contract Compliance: $2.10/$0.30, Pension: $58.80/$8.40,
Administrative Fund: $0.42/$0.06
0
0Landscape Irrigation
Labor
2
Cameron D. Cleland
S
D 0
0
00000
0 3.503.50 0 0 35.437.00
0.00
0.00
0.000.00
128.00 43.40 22.00
0.00
302.62 1214.24
565931366
0.00
15.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
248.01
61473
Other Deduction Detail: SDI: 15.17
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
4.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/09/2019 2016-08/2016-08
3 4 5 6 7 8 9
Medicare
SUN MON TUE WED THU FRI SAT
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.
43.08
694.80
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $176.00/$4.40, Cooperation Comm.: $12.00/$0.30, Training Fund: $53.60/$1.34, Indust. Stab.Fund: $3.20/$0.08, Vacation: $50.40/$1.26, Pension: $170.40/$4.26, Annuity: $10.00/$0.25,
Administrative Fund: $2.40/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 17.3740.00
0.00
0.00
0.000.00
51.00 11.48 10.08
0.00
122.59 572.21
617157389
0.00
6.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
694.80
Apprentice Level 1 61481
Other Deduction Detail: SDI: 6.95
Male
82.91
1337.20
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 33.4340.00
0.00
0.00
0.000.00
126.00 34.23 19.39
0.00
275.90 1061.30
559657836
0.00
13.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1337.20
61498
Other Deduction Detail: SDI: 13.37
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
4.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/09/2019 2016-08/2016-08
3 4 5 6 7 8 9
Medicare
SUN MON TUE WED THU FRI SAT
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 #4.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
3rd
President
December 11th,
2019
Urban Habitat
2019 20192019November9th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI
73.59
1186.91
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $246.51/$7.47, Pension: $277.20/$8.40, Annuity: $16.50/$0.50, Vacation: $160.71/$4.87, Training Fund: $22.77/$0.69, Contract Compliance: $9.90/$0.30, Administrative Fund: $1.98/$0.06,
Indust. Stab.Fund: $3.96/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
8.00 8.0008.00 0 35.4332.00
0.00
0.00
0.000.00
69.00 14.33 17.21
0.00
186.00 1000.91
270717343
0.00
11.87
1)
2)
3)O 0 0 0 0 0 1.00 0 1.00 53.15 0.00
1186.91
61586
Other Deduction Detail: SDI: 11.87
Male Caucasian
79.86
61523.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $325.71/$9.87, Pension: $325.71/$9.87, Vacation: $159.72/$4.84, Training Fund: $49.50/$1.50, Annuity: $8.25/$0.25, Contract Compliance: $9.90/$0.30, Administrative Fund: $1.98/$0.06,
Indust. Stab.Fund: $3.96/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 8.0008.00 0 38.4532.00
0.00
0.00
0.000.00
100.00 26.00 18.67
0.00
250.53 61272.47
565931366
0.00
26.00
1)
2)
3)O 0 0 0 0 0 1.00 0 1.00 57.68 0.00
1288.08
61523
Other Deduction Detail: SDI: 26.00
Male Caucasian
35.81
577.56
Thermal, CA 92274
1278 Bernis Blvd.
Fringe Detail: Administrative Fund: $1.97/$0.06, Training Fund: $43.992/$1.34, Contract Compliance: $9.849/$0.30, Pension: $139.856/$4.26, Health & Welfare: $144.452/$4.40, Indust. Stab.Fund: $2.626/$0.08, Annuity:
$8.207/$0.25, Vacation/ Holiday: $41.366/$1.26
0
0Landscape Irrigation
Labor
2
Enrique Corrales Alcantar
S
D 0
8.00
00000
8.00 8.0008.00 0 17.3732.00
0.00
0.00
0.000.00
19.00 0.38 8.38
0.00
69.34 508.22
767333187
0.00
5.77
1)
2)
3)O 0 0 0 0 0.21 0.62 0 0.83 26.06 0.00
577.47
Apprentice Level 1 DirectDepositosit
Other Deduction Detail: SDI: 5.77
Male
36.07
581.90
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $145.20/$4.40, Cooperation Comm.: $9.90/$0.30, Training Fund: $44.22/$1.34, Indust. Stab.Fund: $2.64/$0.08, Vacation: $41.58/$1.26, Pension: $140.58/$4.26, Annuity: $8.25/$0.25,
Administrative Fund: $1.98/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
8.00
00000
8.00 8.0008.00 0 17.3732.00
0.00
0.00
0.000.00
38.00 6.51 8.44
0.00
94.84 487.06
617157389
0.00
5.82
1)
2)
3)O 0 0 0 0 0 1.00 0 1.00 26.06 0.00
581.90
Apprentice Level 1 61531
Other Deduction Detail: SDI: 5.82
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
5.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/16/2019 2016-08/2016-08
10 11 12 13 14 15 16
Medicare
SUN MON TUE WED THU FRI SAT
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.
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
5.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/16/2019 2016-08/2016-08
10 11 12 13 14 15 16
Medicare
SUN MON TUE WED THU FRI SAT
CA-SC-UHWage
Det:
Check No.
Sex Race
52.85
852.47
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $186.75/$7.47, Pension: $210.00/$8.40, Annuity: $12.50/$0.50, Vacation: $121.75/$4.87, Training Fund: $17.25/$0.69, Contract Compliance: $7.50/$0.30, Administrative Fund: $1.50/$0.06,
Indust. Stab.Fund: $3.00/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
0 8.0008.00 0 33.4324.00
0.00
0.00
0.000.00
68.00 11.41 12.36
0.00
153.15 699.32
559657836
0.00
8.53
1)
2)
3)O 0 0 0 0 0 1.00 0 1.00 50.15 0.00
852.47
61548
Other Deduction Detail: SDI: 8.53
Male
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 #5.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
10th
President
December 15th,
2019
Urban Habitat
2019 20192019November16th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI
76.29
1230.56
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Annuity: $12.00/$0.50, Vacation: $116.88/$4.87, Training Fund: $16.56/$0.69, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06,
Indust. Stab.Fund: $2.88/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
0 8.0008.00 0 35.4324.00
0.00
0.00
0.000.00
74.00 17.21 17.84
0.00
197.65 1032.91
270717343
0.00
12.31
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
850.32
61572
Other Deduction Detail: SDI: 12.31
Male Caucasian
76.29
1230.56
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $59.76/$7.47, Pension: $67.20/$8.40, Annuity: $4.00/$0.50, Vacation: $38.96/$4.87, Training Fund: $5.52/$0.69, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
0
00000
0 08.00 0 0 33.438.00
0.00
0.00
0.000.00
74.00 17.21 17.84
0.00
197.65 1032.91
270717343
0.00
12.31
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
61572
Other Deduction Detail: SDI: 12.31
Male Caucasian
73.41
1184.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $263.36/$8.23, Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Annuity: $16.00/$0.50, Training Fund: $22.08/$0.69, Contract Compliance: $9.60/$0.30, Indust. Stab.Fund: $2.56/$0.08,
Other: $2.24/$0.07, Administrative Fund: $1.92/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
8.00 8.0008.00 0 37.0032.00
0.00
0.00
0.000.00
88.00 18.90 17.16
0.00
233.88 950.12
547439373
0.00
36.41
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1184.00
61595
Other Deduction Detail: SDI: 11.84, Child Support: 24.57
Male
82.53
1331.04
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Indust. Stab.Fund: $0.96/$0.12, Vacation: $38.96/$4.87, Annuity: $4.00/$0.50, Training Fund: $5.52/$0.69, Health & Welfare: $59.76/$7.47, Contract Compliance: $2.40/$0.30, Pension: $67.20/$8.40,
Administrative Fund: $0.48/$0.06
0
0Landscape Irrigation
Labor
2
Cameron D. Cleland
S
D 0
0
00000
0 08.00 0 0 35.438.00
0.00
0.00
0.000.00
106.00 28.23 19.30
0.00
249.37 1081.67
565931366
0.00
13.31
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
283.44
61569
Other Deduction Detail: SDI: 13.31
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
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.
82.53
1331.04
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $236.88/$9.87, Pension: $236.88/$9.87, Vacation: $116.16/$4.84, Training Fund: $36.00/$1.50, Annuity: $6.00/$0.25, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06,
Indust. Stab.Fund: $2.88/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
0 8.0008.00 0 38.4524.00
0.00
0.00
0.000.00
106.00 28.23 19.30
0.00
249.37 1081.67
565931366
0.00
13.31
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
922.80
61569
Other Deduction Detail: SDI: 13.31
Male Caucasian
38.23
616.60
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Health & Welfare: $64.729/$2.45, Pension: $26.42/$1.00, Vacation: $27.213/$1.03, Annuity: $6.605/$0.25
0
0Landscape Irr. Tender
5
Pedro J. Clemente
S
D 0
8.00
00000
8.00 7.7502.67 0 15.3026.42
0.00
0.00
0.000.00
0.00 0.00 8.94
0.00
53.34 563.26
657090571
0.00
6.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
404.22
61605
Other Deduction Detail: SDI: 6.17
Male
34.19
551.50
Thermal, CA 92274
1278 Bernis Blvd.
Fringe Detail: Administrative Fund: $1.425/$0.06, Training Fund: $31.825/$1.34, Contract Compliance: $7.125/$0.30, Pension: $101.175/$4.26, Health & Welfare: $104.50/$4.40, Indust. Stab.Fund: $1.90/$0.08, Annuity:
$5.938/$0.25, Vacation/ Holiday: $29.925/$1.26
0
0Landscape Irrigation
Labor
2
Enrique Corrales Alcantar
S
D 0
8.00
00000
8.00 7.7500 0 17.6723.75
0.00
0.00
0.000.00
16.00 0.00 7.99
0.00
63.70 487.80
767333187
0.00
5.52
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
419.66
Apprentice Level 1 4224
Other Deduction Detail: SDI: 5.52
Male
49.60
800.00
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $16.56/$0.69, Annuity: $12.00/$0.50, Pension: $98.40/$4.10, Contract Compliance: $7.20/$0.30, Indust. Stab.Fund: $1.92/$0.08, Administrative Fund: $1.44/$0.06, Health & Welfare: $105.
60/$4.40, Vacation: $29.76/$1.24
0
0Landscape Irrigation
Labor
5
Maurilio P. Cortez
S
D 0
8.00
00000
8.00 8.0000 0 20.0024.00
0.00
0.00
0.000.00
17.00 0.00 11.60
0.00
86.20 713.80
604521749
0.00
8.00
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
480.00
Apprentice Level 1 61599
Other Deduction Detail: SDI: 8.00
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
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.
34.47
555.84
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $140.80/$4.40, Cooperation Comm.: $9.60/$0.30, Training Fund: $42.88/$1.34, Indust. Stab.Fund: $2.56/$0.08, Vacation: $40.32/$1.26, Pension: $136.32/$4.26, Annuity: $8.00/$0.25,
Administrative Fund: $1.92/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
8.00
00000
0 8.008.00 8.00 0 17.3732.00
0.00
0.00
0.000.00
35.00 5.36 8.06
0.00
88.44 467.40
617157389
0.00
5.55
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
555.84
Apprentice Level 1 61577
Other Deduction Detail: SDI: 5.55
Male
43.08
694.80
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $199.225/$7.47, Pension: $250.698/$9.40, Training Fund: $18.402/$0.69, Annuity: $13.335/$0.50, Vacation: $129.883/$4.87, Contract Compliance: $8.001/$0.30, Administrative Fund: $1.
60/$0.06, Indust. Stab.Fund: $3.20/$0.12
0
0Landscape Irrigation
Labor
1
Luis F. Lopez Quintero
S
D 0
8.00
00000
8.00 8.0002.67 0 17.3726.67
0.00
0.00
0.000.00
32.00 13.97 10.07
0.00
106.07 588.73
164777350
0.00
6.95
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
463.25
Apprentice Level 1 61594
Other Deduction Detail: SDI: 6.95
Male
84.04
1355.51
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $197.357/$7.47, Pension: $221.928/$8.40, Annuity: $13.21/$0.50, Vacation: $128.665/$4.87, Training Fund: $18.23/$0.69, Contract Compliance: $7.926/$0.30, Administrative Fund: $1.
585/$0.06, Indust. Stab.Fund: $3.17/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
8.00
00000
8.00 7.7502.67 0 33.4326.42
0.00
0.00
0.000.00
80.00 22.96 19.66
0.00
220.21 1135.30
604137146
0.00
13.55
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
883.22
61578
Other Deduction Detail: SDI: 13.55
Male
70.21
1132.42
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Annuity: $16.00/$0.50, Vacation: $155.84/$4.87, Training Fund: $22.08/$0.69, Contract Compliance: $9.60/$0.30, Administrative Fund: $1.92/$0.06,
Indust. Stab.Fund: $3.84/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
0 8.008.00 8.00 0 33.4332.00
0.00
0.00
0.000.00
101.00 21.62 16.42
0.00
220.57 911.85
559657836
0.00
11.32
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1069.76
61593
Other Deduction Detail: SDI: 11.32
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
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.
74.34
1199.00
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $177.412/$7.47, Pension: $199.50/$8.40, Vacation: $115.663/$4.87, Training Fund: $16.387/$0.69, Annuity: $11.875/$0.50, Contract Compliance: $7.125/$0.30, Administrative Fund: $1.
425/$0.06, Indust. Stab.Fund: $2.85/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
8.00
00000
8.00 7.7500 0 33.4323.75
0.00
0.00
0.000.00
97.00 45.91 17.38
0.00
246.62 952.38
622987861
0.00
11.99
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
793.96
61600
Other Deduction Detail: SDI: 11.99
Male
84.87
1369.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $304.51/$8.23, Health & Welfare: $276.39/$7.47, Pension: $310.80/$8.40, Annuity: $18.50/$0.50, Training Fund: $25.53/$0.69, Contract Compliance: $11.10/$0.30, Indust. Stab.Fund: $2.96/$0.08,
Administrative Fund: $2.22/$0.06, Other: $2.59/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
8.00
00000
8.00 8.005.00 8.00 0 37.0037.00
0.00
0.00
0.000.00
188.00 70.79 19.86
0.00
377.21 991.79
529802418
0.00
13.69
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1369.00
61581
Other Deduction Detail: SDI: 13.69
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
6.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/23/2019 2016-08/2016-08
17 18 19 20 21 22 23
Medicare
SUN MON TUE WED THU FRI SAT
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, Contractor
License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
17th
President
December 15th,
2019
Urban Habitat
2019 20192019November23rd
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, SDI
32.12
518.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $115.22/$8.23, Health & Welfare: $104.58/$7.47, Pension: $117.60/$8.40, Annuity: $7.00/$0.50, Training Fund: $9.66/$0.69, Contract Compliance: $4.20/$0.30, Indust. Stab.Fund: $1.12/$0.08, Other:
$0.98/$0.07, Administrative Fund: $0.84/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
0
00000
7.00 007.00 0 37.0014.00
0.00
0.00
0.000.00
13.00 0.00 7.52
0.00
82.39 435.61
547439373
0.00
29.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
518.00
61640
Other Deduction Detail: SDI: 5.18, Child Support: 24.57
Male
44.87
723.76
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Annuity: $10.825/$0.50, Training Fund: $14.938/$0.69, Pension: $181.86/$8.40, Health & Welfare: $161.725/$7.47, Vacation: $105.435/$4.87, Contract Compliance: $6.495/$0.30, Administrative Fund: $1.
299/$0.06, Indust. Stab.Fund: $2.598/$0.12
0
0Landscape Irrigation
Labor
5
Pedro J. Clemente
S
D 0
0
00000
5.65 08.00 8.00 0 33.4321.65
0.00
0.00
0.000.00
9.00 0.00 10.50
0.00
71.61 652.15
657090571
0.00
7.24
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
723.76
61650
Other Deduction Detail: SDI: 7.24
Male
26.85
433.00
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $3.898/$0.69, Annuity: $2.825/$0.50, Pension: $23.165/$4.10, Contract Compliance: $1.695/$0.30, Indust. Stab.Fund: $0.452/$0.08, Administrative Fund: $0.339/$0.06, Health & Welfare: $24.
86/$4.40, Vacation: $7.006/$1.24
0
0Landscape Irrigation
Labor
1
Maurilio P. Cortez
S
D 0
0
00000
5.65 000 0 20.005.65
0.00
0.00
0.000.00
0.00 0.00 6.28
0.00
37.46 395.54
604521749
0.00
4.33
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
113.00
Apprentice Level 1 61644
Other Deduction Detail: SDI: 4.33
Male Hispanic American
23.32
376.06
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $95.26/$4.40, Cooperation Comm.: $6.495/$0.30, Training Fund: $29.011/$1.34, Indust. Stab.Fund: $1.732/$0.08, Vacation: $27.279/$1.26, Pension: $92.229/$4.26, Annuity: $5.412/$0.25,
Administrative Fund: $1.299/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
0
00000
5.65 08.00 8.00 0 17.3721.65
0.00
0.00
0.000.00
14.00 0.00 5.45
0.00
46.53 329.53
617157389
0.00
3.76
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
376.06
Apprentice Level 1 61622
Other Deduction Detail: SDI: 3.76
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
7.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/30/2019 2016-08/2016-08
24 25 26 27 28 29 30
Medicare
SUN MON TUE WED THU FRI SAT
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.
23.32
376.06
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $161.725/$7.47, Pension: $203.51/$9.40, Training Fund: $14.938/$0.69, Annuity: $10.825/$0.50, Vacation: $105.435/$4.87, Contract Compliance: $6.495/$0.30, Administrative Fund: $1.
299/$0.06, Indust. Stab.Fund: $2.598/$0.12
0
0Landscape Irrigation
Labor
1
Luis F. Lopez Quintero
S
D 0
0
00000
5.65 08.00 8.00 0 17.3721.65
0.00
0.00
0.000.00
0.00 2.11 5.46
0.00
34.65 341.41
164777350
0.00
3.76
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
376.06
Apprentice Level 1 61639
Other Deduction Detail: SDI: 3.76
Male
73.23
1181.14
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $161.725/$7.47, Pension: $181.86/$8.40, Annuity: $10.825/$0.50, Vacation: $105.435/$4.87, Training Fund: $14.938/$0.69, Contract Compliance: $6.495/$0.30, Administrative Fund: $1.
299/$0.06, Indust. Stab.Fund: $2.598/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
0
00000
5.65 08.00 8.00 0 33.4321.65
0.00
0.00
0.000.00
59.00 11.45 17.13
0.00
172.62 1008.52
604137146
0.00
11.81
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
723.76
61623
Other Deduction Detail: SDI: 11.81
Male
28.42
458.43
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $42.206/$7.47, Pension: $47.46/$8.40, Vacation: $27.516/$4.87, Training Fund: $3.898/$0.69, Annuity: $2.825/$0.50, Contract Compliance: $1.695/$0.30, Administrative Fund: $0.339/$0.06,
Indust. Stab.Fund: $0.678/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
0
00000
5.65 000 0 33.435.65
0.00
0.00
0.000.00
6.00 0.00 6.65
0.00
45.65 412.78
622987861
0.00
4.58
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
188.88
61645
Other Deduction Detail: SDI: 4.58
Male
55.06
888.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $197.52/$8.23, Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Annuity: $12.00/$0.50, Training Fund: $16.56/$0.69, Contract Compliance: $7.20/$0.30, Indust. Stab.Fund: $1.92/$0.08,
Administrative Fund: $1.44/$0.06, Other: $1.68/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
0
00000
8.00 08.00 8.00 0 37.0024.00
0.00
0.00
0.000.00
84.00 26.62 12.87
0.00
187.43 700.57
529802418
0.00
8.88
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
888.00
61626
Other Deduction Detail: SDI: 8.88
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
7.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort11/30/2019 2016-08/2016-08
24 25 26 27 28 29 30
Medicare
SUN MON TUE WED THU FRI SAT
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 #7.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
24th
President
December 15th,
2019
Urban Habitat
2019 20192019November30th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, SDI
64.11
1034.08
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Vacation: $77.92/$4.87, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust.
Stab.Fund: $1.92/$0.12
0
0Landscape Irrigation
Labor
3
Daniel J. Carver
S
D 0
8.00
00000
0 8.0000 0 33.4316.00
0.00
0.00
0.000.00
51.00 7.31 14.99
0.00
147.75 886.33
270717343
0.00
10.34
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
534.88
61665
Other Deduction Detail: SDI: 10.34
Male Caucasian
73.40
1184.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $263.36/$8.23, Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Annuity: $16.00/$0.50, Training Fund: $22.08/$0.69, Contract Compliance: $9.60/$0.30, Indust. Stab.Fund: $2.56/$0.08,
Other: $2.24/$0.07, Administrative Fund: $1.92/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
0 8.008.00 8.00 0 37.0032.00
0.00
0.00
0.000.00
88.00 18.90 17.16
0.00
453.87 730.13
547439373
0.00
256.41
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1184.00
61691
Other Deduction Detail: SDI: 11.84, Tax Levy: 221.50, Child Support: 23.07
Male
97.62
1574.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Indust. Stab.Fund: $0.96/$0.12, Vacation: $38.96/$4.87, Annuity: $4.00/$0.50, Training Fund: $5.52/$0.69, Health & Welfare: $59.76/$7.47, Contract Compliance: $2.40/$0.30, Pension: $67.20/$8.40,
Administrative Fund: $0.48/$0.06
0
0Landscape Irrigation
Labor
2
Cameron D. Cleland
S
D 0
8.00
00000
0 000 0 35.438.00
0.00
0.00
0.000.00
123.00 39.49 22.83
0.00
298.68 1275.32
565931366
0.00
15.74
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
283.44
6166261813
Other Deduction Detail: SDI: 15.74
Male Caucasian
97.62
1574.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Indust. Stab.Fund: $0.96/$0.12, Vacation: $38.96/$4.87, Annuity: $4.00/$0.50, Training Fund: $5.52/$0.69, Health & Welfare: $59.76/$7.47, Contract Compliance: $2.40/$0.30, Pension: $67.20/$8.40,
Administrative Fund: $0.48/$0.06
0
0Landscape Irrigation
Labor
2
Cameron D. Cleland
S
D 0
0
00000
0 08.00 0 0 33.438.00
0.00
0.00
0.000.00
123.00 39.49 22.83
0.00
298.68 1275.32
565931366
0.00
15.74
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
6166261813
Other Deduction Detail: SDI: 15.74
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
8.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
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.
97.62
1574.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $78.96/$9.87, Pension: $78.96/$9.87, Vacation: $38.72/$4.84, Training Fund: $12.00/$1.50, Annuity: $2.00/$0.25, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
0
00000
0 8.0000 0 38.458.00
0.00
0.00
0.000.00
123.00 39.49 22.83
0.00
298.68 1275.32
565931366
0.00
15.74
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
307.60
6166261813
Other Deduction Detail: SDI: 15.74
Male Caucasian
30.36
489.60
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Health & Welfare: $78.40/$2.45, Pension: $32.00/$1.00, Vacation: $32.96/$1.03, Annuity: $8.00/$0.25
0
0Landscape Irr. Tender
5
Pedro J. Clemente
S
D 0
8.00
00000
0 8.008.00 8.00 0 15.3032.00
0.00
0.00
0.000.00
0.00 0.00 7.10
0.00
42.35 447.25
657090571
0.00
4.89
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
489.60
61702
Other Deduction Detail: SDI: 4.89
Male
39.68
640.00
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $22.08/$0.69, Annuity: $16.00/$0.50, Pension: $131.20/$4.10, Contract Compliance: $9.60/$0.30, Indust. Stab.Fund: $2.56/$0.08, Administrative Fund: $1.92/$0.06, Health & Welfare: $140.
80/$4.40, Vacation: $39.68/$1.24
0
0Landscape Irrigation
Labor
5
Maurilio P. Cortez
S
D 0
8.00
00000
0 8.008.00 8.00 0 20.0032.00
0.00
0.00
0.000.00
1.00 0.00 9.28
0.00
56.36 583.64
604521749
0.00
6.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
640.00
Apprentice Level 1 61695
Other Deduction Detail: SDI: 6.40
Male Hispanic American
34.46
555.85
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $35.20/$4.40, Cooperation Comm.: $2.40/$0.30, Training Fund: $10.72/$1.34, Indust. Stab.Fund: $0.64/$0.08, Vacation: $10.08/$1.26, Pension: $34.08/$4.26, Annuity: $2.00/$0.25,
Administrative Fund: $0.48/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
0
00000
0 08.00 0 0 17.378.00
0.00
0.00
0.000.00
35.00 5.36 8.06
0.00
88.44 467.41
617157389
0.00
5.56
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
138.96
Apprentice Level 1 61670
Other Deduction Detail: SDI: 5.56
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
8.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
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.
34.46
555.84
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $239.04/$7.47, Pension: $300.80/$9.40, Training Fund: $22.08/$0.69, Annuity: $16.00/$0.50, Vacation: $155.84/$4.87, Contract Compliance: $9.60/$0.30, Administrative Fund: $1.92/$0.06,
Indust. Stab.Fund: $3.84/$0.12
0
0Landscape Irrigation
Labor
4
Luis F. Lopez Quintero
S
D 0
8.00
00000
0 8.008.00 8.00 0 17.3732.00
0.00
0.00
0.000.00
16.00 7.86 8.06
0.00
71.94 483.90
164777350
0.00
5.56
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
555.84
Apprentice Level 1 61690
Other Deduction Detail: SDI: 5.56
Male
34.81
561.34
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $69.825/$2.45, Pension: $28.50/$1.00, Annuity: $7.125/$0.25, Vacation: $29.355/$1.03
0
0Landscape Irr. Tender
5
Juan LopezMendez
S
D 0
8.00
00000
0 8.008.00 4.50 0 15.3028.50
0.00
0.00
0.000.00
0.00 0.00 8.14
0.00
48.55 512.79
620099088
0.00
5.60
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
436.05
6168861814
Other Deduction Detail: SDI: 5.60
Male
34.81
561.34
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $26.145/$7.47, Pension: $31.15/$8.90, Annuity: $0.875/$0.25, Vacation: $17.045/$4.87, Training Fund: $2.415/$0.69, Indust. Stab.Fund: $28.00/$8.00, Contract Compliance: $0.245/$0.07
0
0Laborer/Group 1
5
Juan LopezMendez
S
D 0
0
00000
0 003.50 0 35.793.50
0.00
0.00
0.000.00
0.00 0.00 8.14
0.00
48.55 512.79
620099088
0.00
5.60
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
125.26
6168861814
Other Deduction Detail: SDI: 5.60
Male
89.78
1448.00
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $153.135/$7.47, Pension: $172.20/$8.40, Annuity: $10.25/$0.50, Vacation: $99.835/$4.87, Training Fund: $14.145/$0.69, Contract Compliance: $6.15/$0.30, Administrative Fund: $1.23/$0.06,
Indust. Stab.Fund: $2.46/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
0
00000
0 8.004.50 8.00 0 35.4320.50
0.00
0.00
0.000.00
91.00 29.85 20.99
0.00
246.10 1201.90
604137146
0.00
14.48
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
726.31
61671
Other Deduction Detail: SDI: 14.48
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
8.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
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.
89.78
1448.00
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $113.505/$9.87, Pension: $113.505/$9.87, Vacation: $55.66/$4.84, Annuity: $2.875/$0.25, Training Fund: $17.25/$1.50, Contract Compliance: $3.45/$0.30, Administrative Fund: $0.69/$0.06,
Indust. Stab.Fund: $138.00/$12.00
0
0Landscape Oper. Eng
5
Felipe Lopez
S
D 0
8.00
00000
0 03.50 0 0 38.4511.50
0.00
0.00
0.000.00
91.00 29.85 20.99
0.00
246.10 1201.90
604137146
0.00
14.48
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
442.17
61671
Other Deduction Detail: SDI: 14.48
Male
77.72
1253.52
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Annuity: $12.00/$0.50, Vacation: $116.88/$4.87, Training Fund: $16.56/$0.69, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06,
Indust. Stab.Fund: $2.88/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
0
00000
8.00 8.008.00 0 0 33.4324.00
0.00
0.00
0.000.00
116.00 28.71 18.17
0.00
253.13 1000.39
559657836
0.00
12.53
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
802.32
61689
Other Deduction Detail: SDI: 12.53
Male
66.66
1075.11
Indio, CA 92201
81921 Victoria St.
Fringe Detail: Administrative Fund: $0.15/$0.06, Pension: $21.00/$8.40, Annuity: $1.25/$0.50, Vacation: $12.175/$4.87, Contract Compliance: $0.75/$0.30, Indust. Stab.Fund: $0.30/$0.12, Health & Welfare: $18.675/$7.47,
Training Fund: $1.725/$0.69
0
0Landscape Irrigation
Labor
0
Gerardo Saldivar Mejia
S
D 0
0
00000
0 02.50 0 0 33.432.50
0.00
0.00
0.000.00
94.00 19.10 15.59
0.00
206.10 869.01
607068060
0.00
10.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
83.57
61673
Other Deduction Detail: SDI: 10.75
Male Hispanic American
66.76
1076.77
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $26.145/$7.47, Pension: $29.40/$8.40, Vacation: $17.045/$4.87, Training Fund: $2.415/$0.69, Annuity: $1.75/$0.50, Contract Compliance: $1.05/$0.30, Administrative Fund: $0.21/$0.06,
Indust. Stab.Fund: $0.42/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
0
00000
0 03.50 0 0 35.433.50
0.00
0.00
0.000.00
75.00 32.14 15.61
0.00
200.29 876.48
622987861
0.00
10.78
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
124.00
6169661815
Other Deduction Detail: SDI: 10.78
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
8.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
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.
66.76
1076.77
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $212.895/$7.47, Pension: $239.40/$8.40, Vacation: $138.795/$4.87, Training Fund: $19.665/$0.69, Annuity: $14.25/$0.50, Contract Compliance: $8.55/$0.30, Administrative Fund: $1.71/$0.06,
Indust. Stab.Fund: $3.42/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
8.00
00000
0 8.004.50 8.00 0 33.4328.50
0.00
0.00
0.000.00
75.00 32.14 15.61
0.00
200.29 876.48
622987861
0.00
10.78
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
952.75
6169661815
Other Deduction Detail: SDI: 10.78
Male
73.41
1184.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $263.36/$8.23, Health & Welfare: $239.04/$7.47, Pension: $268.80/$8.40, Annuity: $16.00/$0.50, Training Fund: $22.08/$0.69, Contract Compliance: $9.60/$0.30, Indust. Stab.Fund: $2.56/$0.08,
Administrative Fund: $1.92/$0.06, Other: $2.24/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
8.00
00000
0 8.008.00 8.00 0 37.0032.00
0.00
0.00
0.000.00
147.00 51.87 17.17
0.00
301.29 882.71
529802418
0.00
11.84
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1184.00
61675
Other Deduction Detail: SDI: 11.84
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
8.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/07/2019 2016-08/2016-08
1 2 3 4 5 6 7
Medicare
SUN MON TUE WED THU FRI SAT
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 #8.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
1st
President
December 28th,
2019
Urban Habitat
2019 20192019December7th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, SDI, Tax Levy
45.88
740.00
Riverside, CA 92507
4046 Dwight Ave.
Fringe Detail: Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Pension: $164.00/$4.10, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08, Administrative Fund: $2.40/$0.06, Health & Welfare: $176.
00/$4.40, Vacation: $49.60/$1.24
0
0Cement Mason
3
Josue Arce
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 18.5040.00
0.00
0.00
0.000.00
47.00 11.86 10.73
0.00
122.87 617.13
611506098
0.00
7.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
740.00
Apprentice Level 1 61738
Other Deduction Detail: SDI: 7.40
Male Hispanic American
81.20
1309.68
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $97.11/$7.47, Pension: $109.20/$8.40, Annuity: $6.50/$0.50, Vacation: $63.31/$4.87, Training Fund: $8.97/$0.69, Contract Compliance: $3.90/$0.30, Administrative Fund: $0.78/$0.06, Indust.
Stab.Fund: $1.56/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
5.00
00000
0 8.0000 0 35.4313.00
0.00
0.00
0.000.00
84.00 22.43 18.99
0.00
219.72 1089.96
270717343
0.00
13.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
460.59
61717
Other Deduction Detail: SDI: 13.10
Male Caucasian
81.20
1309.68
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $22.41/$7.47, Pension: $25.20/$8.40, Annuity: $1.50/$0.50, Vacation: $14.61/$4.87, Training Fund: $2.07/$0.69, Contract Compliance: $0.90/$0.30, Administrative Fund: $0.18/$0.06, Indust.
Stab.Fund: $0.36/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
3.00
00000
0 000 0 33.433.00
0.00
0.00
0.000.00
84.00 22.43 18.99
0.00
219.72 1089.96
270717343
0.00
13.10
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
100.29
61717
Other Deduction Detail: SDI: 13.10
Male Caucasian
91.76
1480.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $329.20/$8.23, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08,
Other: $2.80/$0.07, Administrative Fund: $2.40/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 37.0040.00
0.00
0.00
0.000.00
124.00 33.71 21.46
0.00
410.30 1069.70
547439373
0.00
139.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1480.00
61743
Other Deduction Detail: SDI: 14.80, Child Support: 23.07, Child Support Fee: 1.50, State Tax Lien: 100.00
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
9.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
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.
104.56
1686.38
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $128.31/$9.87, Pension: $128.31/$9.87, Vacation: $62.92/$4.84, Training Fund: $19.50/$1.50, Annuity: $3.25/$0.25, Contract Compliance: $3.90/$0.30, Administrative Fund: $0.78/$0.06,
Indust. Stab.Fund: $1.56/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
5.00
00000
0 8.0000 0 38.4513.00
0.00
0.00
0.000.00
148.00 59.02 24.45
0.00
352.90 1333.48
565931366
0.00
16.87
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
499.85
61714
Other Deduction Detail: SDI: 16.87
Male Caucasian
104.56
1686.38
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Indust. Stab.Fund: $0.36/$0.12, Vacation: $14.61/$4.87, Annuity: $1.50/$0.50, Training Fund: $2.07/$0.69, Health & Welfare: $22.41/$7.47, Contract Compliance: $0.90/$0.30, Pension: $25.20/$8.40,
Administrative Fund: $0.18/$0.06
0
0Landscape Irrigation
Labor
2
Cameron D. Cleland
S
D 0
3.00
00000
0 000 0 35.433.00
0.00
0.00
0.000.00
148.00 59.02 24.45
0.00
352.90 1333.48
565931366
0.00
16.87
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
106.29
61714
Other Deduction Detail: SDI: 16.87
Male Caucasian
70.69
1140.20
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $5.52/$0.69, Annuity: $4.00/$0.50, Pension: $32.80/$4.10, Contract Compliance: $2.40/$0.30, Indust. Stab.Fund: $0.64/$0.08, Administrative Fund: $0.48/$0.06, Health & Welfare: $35.20/$4.40,
Vacation: $9.92/$1.24
0
0Landscape Irrigation
Labor
4
Maurilio P. Cortez
S
D 0
0
00000
0 08.00 0 0 20.008.00
0.00
0.00
0.000.00
54.00 9.48 16.53
0.00
162.10 978.10
604521749
0.00
11.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
160.00
Apprentice Level 1 61747
Other Deduction Detail: STAN: 11.40
Male Hispanic American
66.52
1072.89
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $116.756/$7.47, Pension: $146.922/$9.40, Training Fund: $10.785/$0.69, Annuity: $7.815/$0.50, Vacation: $76.118/$4.87, Contract Compliance: $4.689/$0.30, Administrative Fund: $0.
938/$0.06, Indust. Stab.Fund: $1.876/$0.12
0
0Landscape Irrigation
Labor
4
Luis F. Lopez Quintero
S
D 0
0
00000
0 08.00 7.63 0 17.3715.63
0.00
0.00
0.000.00
77.00 41.79 15.55
0.00
211.58 861.31
164777350
0.00
10.72
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
271.49
Apprentice Level 1 61742
Other Deduction Detail: SDI: 10.72
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
9.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
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.
78.40
1264.57
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $116.756/$7.47, Pension: $139.107/$8.90, Annuity: $0.875/$0.056, Vacation: $76.118/$4.87, Training Fund: $10.785/$0.69, Indust. Stab.Fund: $125.04/$8.00, Contract Compliance: $0.
245/$0.016
0
0Laborer/Group 1
5
Juan LopezMendez
S
D 0
0
00000
0 08.00 7.63 0 35.7915.63
0.00
0.00
0.000.00
69.00 16.96 18.33
0.00
195.34 1069.23
620099088
0.00
12.65
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
559.39
61740
Other Deduction Detail: SDI: 12.65
Male
113.99
1838.57
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $56.996/$7.47, Pension: $64.092/$8.40, Annuity: $3.815/$0.50, Vacation: $37.158/$4.87, Training Fund: $5.265/$0.69, Contract Compliance: $2.289/$0.30, Administrative Fund: $0.458/$0.06,
Indust. Stab.Fund: $0.916/$0.12
0
0Landscape Irrigation
Labor
1
Felipe Lopez
S
D 0
0
00000
0 007.63 0 35.437.63
0.00
0.00
0.000.00
137.00 67.10 26.66
0.00
363.14 1475.43
604137146
0.00
18.39
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
270.33
61723
Other Deduction Detail: SDI: 18.39
Male
113.99
1838.57
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $78.96/$9.87, Pension: $78.96/$9.87, Vacation: $38.72/$4.84, Annuity: $2.00/$0.25, Training Fund: $12.00/$1.50, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $96.00/$12.00
0
0Landscape Oper. Eng
1
Felipe Lopez
S
D 0
0
00000
0 08.00 0 0 38.458.00
0.00
0.00
0.000.00
137.00 67.10 26.66
0.00
363.14 1475.43
604137146
0.00
18.39
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
307.60
61723
Other Deduction Detail: SDI: 18.39
Male
75.13
1211.68
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Vacation: $77.92/$4.87, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust.
Stab.Fund: $1.92/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
0 8.0000 0 33.4316.00
0.00
0.00
0.000.00
111.00 25.95 17.57
0.00
241.77 969.91
559657836
0.00
12.12
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
534.88
61741
Other Deduction Detail: SDI: 12.12
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
9.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
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.
74.72
1205.16
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $59.76/$7.47, Pension: $67.20/$8.40, Vacation: $38.96/$4.87, Training Fund: $5.52/$0.69, Annuity: $4.00/$0.50, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
0
00000
0 08.00 0 0 33.438.00
0.00
0.00
0.000.00
98.00 46.54 17.48
0.00
248.79 956.37
622987861
0.00
12.05
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
61748
Other Deduction Detail: SDI: 12.05
Male
91.76
1480.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $329.20/$8.23, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08,
Administrative Fund: $2.40/$0.06, Other: $2.80/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 37.0040.00
0.00
0.00
0.000.00
212.00 82.15 21.46
0.00
422.17 1057.83
529802418
0.00
14.80
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1480.00
617217
Other Deduction Detail: SDI: 14.80
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
9.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/14/2019 2016-08/2016-08
8 9 10 11 12 13 14
Medicare
SUN MON TUE WED THU FRI SAT
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 #9.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
8th
President
January 16th, 2020
Urban Habitat
2019 20192019December14th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, SDI, STAN,
State Tax Lien
45.88
740.00
Riverside, CA 92507
4046 Dwight Ave.
Fringe Detail: Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Pension: $164.00/$4.10, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08, Administrative Fund: $2.40/$0.06, Health & Welfare: $176.
00/$4.40, Vacation: $49.60/$1.24
0
0Cement Mason
3
Josue Arce
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 18.5040.00
0.00
0.00
0.000.00
47.00 11.86 10.73
0.00
122.87 617.13
611506098
0.00
7.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
740.00
Apprentice Level 1 61789
Other Deduction Detail: SDI: 7.40
Male Hispanic American
108.42
1417.20
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 35.4340.00
0.00
0.00
0.000.00
87.00 24.25 20.55
0.00
254.39 1162.81
270717343
0.00
14.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1417.20
6176861985
Other Deduction Detail: SDI: 14.17
Male Caucasian
91.76
1480.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $329.20/$8.23, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08,
Other: $2.80/$0.07, Administrative Fund: $2.40/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 37.0040.00
0.00
0.00
0.000.00
124.00 33.71 21.46
0.00
410.30 1069.70
547439373
0.00
139.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1480.00
61794
Other Deduction Detail: SDI: 14.80, Child Support Fee: 1.50, Child Support: 23.07, State Tax Lien: 100.00
Male
95.35
1538.00
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $394.80/$9.87, Pension: $394.80/$9.87, Vacation: $193.60/$4.84, Training Fund: $60.00/$1.50, Annuity: $10.00/$0.25, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 38.4540.00
0.00
0.00
0.000.00
130.00 45.26 22.30
0.00
308.29 1229.71
565931366
0.00
15.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1538.00
61765
Other Deduction Detail: Section 125: 15.38
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
10.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/21/2019 2016-08/2016-08
15 16 17 18 19 20 21
Medicare
SUN MON TUE WED THU FRI SAT
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.
25.85
416.88
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $105.60/$4.40, Cooperation Comm.: $7.20/$0.30, Training Fund: $32.16/$1.34, Indust. Stab.Fund: $1.92/$0.08, Vacation: $30.24/$1.26, Pension: $102.24/$4.26, Annuity: $6.00/$0.25,
Administrative Fund: $1.44/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
0
00000
8.00 8.0008.00 0 17.3724.00
0.00
0.00
0.000.00
18.00 0.51 6.05
0.00
54.58 362.30
617157389
0.00
4.17
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
416.88
Apprentice Level 1 61773
Other Deduction Detail: SDI: 4.17
Male
82.90
1337.20
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Vacation: $194.80/$4.87, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Administrative Fund: $2.40/$0.06,
Indust. Stab.Fund: $4.80/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 33.4340.00
0.00
0.00
0.000.00
126.00 34.23 19.39
0.00
275.89 1061.31
559657836
0.00
13.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1337.20
61792
Other Deduction Detail: SDI: 13.37
Male
69.39
11119.25
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $314.798/$8.23, Health & Welfare: $285.727/$7.47, Pension: $321.30/$8.40, Annuity: $19.125/$0.50, Training Fund: $26.392/$0.69, Contract Compliance: $11.475/$0.30, Indust. Stab.Fund: $3.
06/$0.08, Administrative Fund: $2.295/$0.06, Other: $2.678/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
6.25
00000
8.00 8.008.00 8.00 0 37.0038.25
0.00
0.00
0.000.00
133.00 45.87 16.23
0.00
275.68 10843.57
529802418
0.00
11.19
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1415.25
61778
Other Deduction Detail: SDI: 11.19
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
10.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/21/2019 2016-08/2016-08
15 16 17 18 19 20 21
Medicare
SUN MON TUE WED THU FRI SAT
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 #10.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
15th
President
January 16th, 2020
Urban Habitat
2019 20192019December21st
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, SDI, Section
125, State Tax Lien
7.59
122.40
Coachella, CA 92236
84711 Ave 51
Fringe Detail: Health & Welfare: $19.60/$2.45, Pension: $8.00/$1.00, Annuity: $2.00/$0.25, Vacation: $8.24/$1.03
0
0Landscape Irr. Tender
3
Alejandro Aguayo
S
D 0
8.00
00000
0 000 0 15.308.00
0.00
0.00
0.000.00
0.00 0.00 1.77
0.00
10.58 111.82
616926918
0.00
1.22
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
122.40
61817
Other Deduction Detail: SDI: 1.22
Male Hispanic American
4.59
74.00
Riverside, CA 92507
4046 Dwight Ave.
Fringe Detail: Annuity: $2.00/$0.50, Training Fund: $2.76/$0.69, Pension: $16.40/$4.10, Contract Compliance: $1.20/$0.30, Indust. Stab.Fund: $0.32/$0.08, Administrative Fund: $0.24/$0.06, Health & Welfare: $17.60/$4.40,
Vacation: $4.96/$1.24
0
0Cement Mason
3
Josue Arce
S
D 0
0
00000
0 04.00 0 0 18.504.00
0.00
0.00
0.000.00
0.00 0.00 1.07
0.00
6.40 67.60
611506098
0.00
0.74
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
74.00
Apprentice Level 1 61844
Other Deduction Detail: SDI: 0.74
Male Hispanic American
12.79
206.29
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $22.41/$7.47, Pension: $25.20/$8.40, Annuity: $1.50/$0.50, Vacation: $14.61/$4.87, Training Fund: $2.07/$0.69, Contract Compliance: $0.90/$0.30, Administrative Fund: $0.18/$0.06, Indust.
Stab.Fund: $0.36/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
3.00
00000
0 000 0 35.433.00
0.00
0.00
0.000.00
0.00 0.00 2.99
0.00
17.84 188.45
270717343
0.00
2.06
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
106.29
61822
Other Deduction Detail: SDI: 2.06
Male Caucasian
9.18
148.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $32.92/$8.23, Health & Welfare: $29.88/$7.47, Pension: $33.60/$8.40, Annuity: $2.00/$0.50, Training Fund: $2.76/$0.69, Contract Compliance: $1.20/$0.30, Indust. Stab.Fund: $0.32/$0.08, Other:
$0.28/$0.07, Administrative Fund: $0.24/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
0
00000
0 04.00 0 0 37.004.00
0.00
0.00
0.000.00
0.00 0.00 2.15
0.00
137.38 10.62
547439373
0.00
126.05
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
148.00
61847
Other Deduction Detail: SDI: 14.80, Child Support Fee: 1.50, Child Support: 23.07, State Tax Lien: 86.68
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
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.
29.21
471.05
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $88.83/$9.87, Pension: $88.83/$9.87, Vacation: $43.56/$4.84, Training Fund: $13.50/$1.50, Annuity: $2.25/$0.25, Contract Compliance: $2.70/$0.30, Administrative Fund: $0.54/$0.06, Indust.
Stab.Fund: $1.08/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
5.00
00000
0 04.00 0 0 38.459.00
0.00
0.00
0.000.00
8.00 0.00 6.83
0.00
48.75 422.30
565931366
0.00
4.71
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
346.05
61819
Other Deduction Detail: SDI: 4.71
Male Caucasian
27.13
437.50
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Annuity: $2.40/$0.50, Training Fund: $3.312/$0.69, Pension: $40.32/$8.40, Health & Welfare: $35.856/$7.47, Vacation: $23.376/$4.87, Contract Compliance: $1.44/$0.30, Administrative Fund: $0.288/$0.06,
Indust. Stab.Fund: $0.576/$0.12
0
0Landscape Irrigation
Labor
5
Pedro J. Clemente
S
D 0
0
00000
0 04.80 0 0 35.434.80
0.00
0.00
0.000.00
0.00 0.00 6.34
0.00
37.85 399.65
657090571
0.00
4.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
170.06
61857
Other Deduction Detail: SDI: 4.38
Male
27.13
437.50
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Annuity: $4.00/$0.50, Training Fund: $5.52/$0.69, Pension: $67.20/$8.40, Health & Welfare: $59.76/$7.47, Vacation: $38.96/$4.87, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Irrigation
Labor
5
Pedro J. Clemente
S
D 0
8.00
00000
0 000 0 33.438.00
0.00
0.00
0.000.00
0.00 0.00 6.34
0.00
37.85 399.65
657090571
0.00
4.38
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
61857
Other Deduction Detail: SDI: 4.38
Male
15.87
256.00
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $8.832/$0.69, Annuity: $6.40/$0.50, Pension: $52.48/$4.10, Contract Compliance: $3.84/$0.30, Indust. Stab.Fund: $1.024/$0.08, Administrative Fund: $0.768/$0.06, Health & Welfare: $56.
32/$4.40, Vacation: $15.872/$1.24
0
0Landscape Irrigation
Labor
5
Maurilio P. Cortez
S
D 0
8.00
00000
0 04.80 0 0 20.0012.80
0.00
0.00
0.000.00
0.00 0.00 3.71
0.00
22.14 233.86
604521749
0.00
2.56
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
256.00
Apprentice Level 1 61850
Other Deduction Detail: SDI: 2.56
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
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.
17.23
277.92
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $35.20/$4.40, Cooperation Comm.: $2.40/$0.30, Training Fund: $10.72/$1.34, Indust. Stab.Fund: $0.64/$0.08, Vacation: $10.08/$1.26, Pension: $34.08/$4.26, Annuity: $2.00/$0.25,
Administrative Fund: $0.48/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
4.00
00000
0 04.00 0 0 17.378.00
0.00
0.00
0.000.00
4.00 0.00 4.03
0.00
28.04 249.88
617157389
0.00
2.78
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
138.96
Apprentice Level 1 61827
Other Deduction Detail: SDI: 2.78
Male
13.79
222.34
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $95.616/$7.47, Pension: $120.32/$9.40, Training Fund: $8.832/$0.69, Annuity: $6.40/$0.50, Vacation: $62.336/$4.87, Contract Compliance: $3.84/$0.30, Administrative Fund: $0.768/$0.06,
Indust. Stab.Fund: $1.536/$0.12
0
0Landscape Irrigation
Labor
4
Luis F. Lopez Quintero
S
D 0
8.00
00000
0 04.80 0 0 17.3712.80
0.00
0.00
0.000.00
0.00 0.00 3.22
0.00
19.23 203.11
164777350
0.00
2.22
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
222.33
Apprentice Level 1 61846
Other Deduction Detail: SDI: 2.22
Male
9.94
160.46
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Annuity: $2.40/$0.50, Pension: $40.32/$8.40, Training Fund: $3.312/$0.69, Vacation: $23.376/$4.87, Health & Welfare: $35.856/$7.47, Contract Compliance: $3.312/$0.69, Administrative Fund: $0.288/$0.06,
Indust. Stab.Fund: $0.576/$0.12
0
0Landscape Irrigation
Labor
5
Juan LopezMendez
S
D 0
0
00000
0 04.80 0 0 33.434.80
0.00
0.00
0.000.00
0.00 0.00 2.33
0.00
13.88 146.58
620099088
0.00
1.61
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
160.46
61844
Other Deduction Detail: SDI: 1.61
Male
30.51
492.16
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $126.336/$9.87, Pension: $126.336/$9.87, Vacation: $61.952/$4.84, Annuity: $3.20/$0.25, Training Fund: $19.20/$1.50, Contract Compliance: $3.84/$0.30, Administrative Fund: $0.768/$0.06,
Indust. Stab.Fund: $153.60/$12.00
0
0Landscape Oper. Eng
5
Felipe Lopez
S
D 0
8.00
00000
0 04.80 0 0 38.4512.80
0.00
0.00
0.000.00
0.00 0.00 7.14
0.00
42.57 449.59
604137146
0.00
4.92
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
492.16
61828
Other Deduction Detail: SDI: 4.92
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
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.
7.59
122.40
Indio, CA 92201
82292 Lemongrove
Fringe Detail: Annuity: $2.00/$0.25, Health & Welfare: $19.60/$2.45, Vacation: $8.24/$1.03, Pension: $8.00/$1.00
0
0Landscape Irr. Tender
2
Jose A. Meza Vera
S
D 0
8.00
00000
0 000 0 15.308.00
0.00
0.00
0.000.00
0.00 0.00 1.77
0.00
10.58 111.82
622188359
0.00
1.22
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
122.40
61838
Other Deduction Detail: SDI: 1.22
Male Hispanic American
3.73
257.15
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $22.41/$7.47, Pension: $25.20/$8.40, Annuity: $1.50/$0.50, Vacation: $14.61/$4.87, Training Fund: $2.07/$0.69, Contract Compliance: $0.90/$0.30, Administrative Fund: $0.18/$0.06, Indust.
Stab.Fund: $0.36/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
3.00
00000
0 000 0 33.433.00
0.00
0.00
0.000.00
0.00 15.94 3.00
0.00
25.24 231.91
559657836
0.00
2.57
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
100.29
61845
Other Deduction Detail: SDI: 2.57
Male
16.58
267.44
Coachella, CA 92236
51285 Frederick St
Fringe Detail: Annuity: $4.00/$0.50, Pension: $67.20/$8.40, Health & Welfare: $59.76/$7.47, Vacation: $38.96/$4.87, Administrative Fund: $0.48/$0.06, Training Fund: $5.52/$0.69, Contract Compliance: $2.40/$0.30, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Irrigation
Labor
3
Otoniel A. Penalosa
S
D 0
8.00
00000
0 000 0 33.438.00
0.00
0.00
0.000.00
0.00 0.00 3.88
0.00
23.13 244.31
621666061
0.00
2.67
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
61855
Other Deduction Detail: SDI: 2.67
Male Hispanic American
17.08
275.44
Indio, CA 92201
81921 Victoria St.
Fringe Detail: Administrative Fund: $0.24/$0.06, Pension: $33.60/$8.40, Annuity: $2.00/$0.50, Vacation: $19.48/$4.87, Contract Compliance: $1.20/$0.30, Indust. Stab.Fund: $0.48/$0.12, Health & Welfare: $29.88/$7.47,
Training Fund: $2.76/$0.69
0
0Landscape Irrigation
Labor
0
Gerardo Saldivar Mejia
S
D 0
4.00
00000
0 000 0 33.434.00
0.00
0.00
0.000.00
5.00 0.00 3.99
0.00
28.82 246.62
607068060
0.00
2.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
133.72
61830
Other Deduction Detail: SDI: 2.75
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
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.
17.08
275.44
Indio, CA 92201
81921 Victoria St.
Fringe Detail: Administrative Fund: $0.24/$0.06, Pension: $33.60/$8.40, Annuity: $2.00/$0.50, Vacation: $19.48/$4.87, Contract Compliance: $1.20/$0.30, Indust. Stab.Fund: $0.48/$0.12, Health & Welfare: $29.88/$7.47,
Training Fund: $2.76/$0.69
0
0Landscape Irrigation
Labor
0
Gerardo Saldivar Mejia
S
D 0
4.00
00000
0 000 0 35.434.00
0.00
0.00
0.000.00
5.00 0.00 3.99
0.00
28.82 246.62
607068060
0.00
2.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
141.72
61830
Other Deduction Detail: SDI: 2.75
Male Hispanic American
8.43
136.00
Thermal, CA 92274
56725 Harrison St.
Fringe Detail: Health & Welfare: $19.60/$2.45, Pension: $8.00/$1.00, Vacation: $8.24/$1.03, Annuity: $2.00/$0.25
0
0Landscape Irr. Tender
0
Rafael Sanchez Garcia
S
D 0
8.00
00000
0 000 0 17.008.00
0.00
0.00
0.000.00
0.00 0.00 1.97
0.00
11.76 124.24
614126878
0.00
1.36
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
136.00
61859
Other Deduction Detail: SDI: 1.36
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
11.0 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort12/28/2019 2016-08/2016-08
22 23 24 25 26 27 28
Medicare
SUN MON TUE WED THU FRI SAT
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 #11, Contractor
License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
22nd
President
January 16th, 2020
Urban Habitat
2019 20192019December28th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, SDI, State Tax
Lien
18.35
296.00
Riverside, CA 92507
4046 Dwight Ave.
Fringe Detail: Annuity: $8.00/$0.50, Training Fund: $11.04/$0.69, Pension: $65.60/$4.10, Contract Compliance: $4.80/$0.30, Indust. Stab.Fund: $1.28/$0.08, Administrative Fund: $0.96/$0.06, Health & Welfare: $70.40/$4.40,
Vacation: $19.84/$1.24
0
0Cement Mason
3
Josue Arce
S
D 0
8.00
00000
0 008.00 0 18.5016.00
0.00
0.00
0.000.00
0.00 0.00 4.30
0.00
25.61 270.39
611506098
0.00
2.96
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
296.00
Apprentice Level 1 61891
Other Deduction Detail: SDI: 2.96
Male Hispanic American
26.50
427.44
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $59.76/$7.47, Pension: $67.20/$8.40, Annuity: $4.00/$0.50, Vacation: $38.96/$4.87, Training Fund: $5.52/$0.69, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
0
00000
0 8.0000 0 33.438.00
0.00
0.00
0.000.00
0.00 0.00 6.20
0.00
36.98 390.46
270717343
0.00
4.28
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
267.44
61870
Other Deduction Detail: SDI: 4.28
Male Caucasian
55.05
888.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $197.52/$8.23, Health & Welfare: $179.28/$7.47, Pension: $201.60/$8.40, Annuity: $12.00/$0.50, Training Fund: $16.56/$0.69, Contract Compliance: $7.20/$0.30, Indust. Stab.Fund: $1.92/$0.08,
Other: $1.68/$0.07, Administrative Fund: $1.44/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
0 8.0008.00 0 37.0024.00
0.00
0.00
0.000.00
52.00 6.81 12.87
0.00
260.18 627.82
547439373
0.00
133.45
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
888.00
61895
Other Deduction Detail: SDI: 8.88, Child Support Fee: 1.50, Child Support: 23.07, State Tax Lien: 100.00
Male
50.54
815.20
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $78.96/$9.87, Pension: $78.96/$9.87, Vacation: $38.72/$4.84, Training Fund: $12.00/$1.50, Annuity: $2.00/$0.25, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust.
Stab.Fund: $0.96/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
0
00000
0 8.0000 0 38.458.00
0.00
0.00
0.000.00
43.00 5.20 11.82
0.00
118.71 696.49
565931366
0.00
8.15
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
307.60
61867
Other Deduction Detail: SDI: 8.15
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
12.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/04/2020 2016-08/2016-08
29 30 31 1 2 3 4
Medicare
SUN MON TUE WED THU FRI SAT
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.
23.39
377.28
Thermal, CA 92274
68990 Harrison St. Space #101
Fringe Detail: Health & Welfare: $45.766/$2.45, Pension: $18.68/$1.00, Vacation: $19.24/$1.03, Annuity: $4.67/$0.25
0
0Landscape Irr. Tender
5
Pedro J. Clemente
S
D 0
4.23
00000
0 6.458.00 0 0 15.3018.68
0.00
0.00
0.000.00
0.00 0.00 5.47
0.00
32.63 344.65
657090571
0.00
3.77
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
285.80
61906
Other Deduction Detail: SDI: 3.77
Male
34.60
558.00
Thermal, CA 92274
55550 Tyler St.
Fringe Detail: Training Fund: $11.199/$0.69, Annuity: $8.115/$0.50, Pension: $66.543/$4.10, Contract Compliance: $4.869/$0.30, Indust. Stab.Fund: $1.298/$0.08, Administrative Fund: $0.974/$0.06, Health & Welfare:
$71.412/$4.40, Vacation: $20.125/$1.24
0
0Landscape Irrigation
Labor
5
Maurilio P. Cortez
S
D 0
8.00
00000
0 08.00 0 0 20.0016.00
0.00
0.00
0.000.00
0.00 0.00 8.09
0.00
48.27 509.73
604521749
0.00
5.58
1)
2)
3)O 0 0 0 0 0 0.23 0 0.23 30.00 0.00
326.90
Apprentice Level 1 61899
Other Deduction Detail: SDI: 5.58
Male Hispanic American
17.23
277.92
Thermal, CA 92274
61101 Grapefruit Blvd. #6
Fringe Detail: Health & Welfare: $70.40/$4.40, Cooperation Comm.: $4.80/$0.30, Training Fund: $21.44/$1.34, Indust. Stab.Fund: $1.28/$0.08, Vacation: $20.16/$1.26, Pension: $68.16/$4.26, Annuity: $4.00/$0.25,
Administrative Fund: $0.96/$0.06
0
0Landscape Irrigation
Labor
2
Ernesto Gonzalez Torres
S
D 0
0
00000
0 8.008.00 0 0 17.3716.00
0.00
0.00
0.000.00
4.00 0.00 4.03
0.00
28.04 249.88
617157389
0.00
2.78
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
277.92
Apprentice Level 1 61875
Other Deduction Detail: SDI: 2.78
Male
26.55
428.31
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $139.54/$7.47, Pension: $175.592/$9.40, Training Fund: $12.889/$0.69, Annuity: $9.34/$0.50, Vacation: $90.972/$4.87, Contract Compliance: $5.604/$0.30, Administrative Fund: $1.121/$0.06,
Indust. Stab.Fund: $2.242/$0.12
0
0Landscape Irrigation
Labor
4
Luis F. Lopez Quintero
S
D 0
4.23
00000
0 6.458.00 0 0 17.3718.68
0.00
0.00
0.000.00
2.00 3.06 6.21
0.00
42.11 386.20
164777350
0.00
4.29
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
324.47
Apprentice Level 1 61894
Other Deduction Detail: SDI: 4.29
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
12.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/04/2020 2016-08/2016-08
29 30 31 1 2 3 4
Medicare
SUN MON TUE WED THU FRI SAT
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.
60.78
980.23
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $93.765/$9.87, Pension: $93.765/$9.87, Vacation: $45.98/$4.84, Annuity: $2.375/$0.25, Training Fund: $14.25/$1.50, Contract Compliance: $2.85/$0.30, Administrative Fund: $0.57/$0.06,
Indust. Stab.Fund: $114.00/$12.00
0
0Landscape Oper. Eng
5
Felipe Lopez
S
D 0
0
00000
0 1.508.00 0 0 38.459.50
0.00
0.00
0.000.00
34.00 1.15 14.21
0.00
119.94 860.29
604137146
0.00
9.80
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
365.27
61870
Other Deduction Detail: SDI: 9.80
Male
60.78
980.23
Desert Hot Springs, CA 92240
66886 Camino Idilio
Fringe Detail: Health & Welfare: $80.153/$7.47, Pension: $90.132/$8.40, Annuity: $5.365/$0.50, Vacation: $52.255/$4.87, Training Fund: $7.404/$0.69, Contract Compliance: $3.219/$0.30, Administrative Fund: $0.644/$0.06,
Indust. Stab.Fund: $1.288/$0.12
0
0Landscape Irrigation
Labor
5
Felipe Lopez
S
D 0
4.00
00000
0 6.5000 0 33.4310.50
0.00
0.00
0.000.00
34.00 1.15 14.21
0.00
119.94 860.29
604137146
0.00
9.80
1)
2)
3)O 0 0 0 0 0 0.23 0 0.23 50.14 0.00
362.54
61870
Other Deduction Detail: SDI: 9.80
Male
32.09
878.88
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Vacation: $77.92/$4.87, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust.
Stab.Fund: $1.92/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
0
00000
0 8.008.00 0 0 33.4316.00
0.00
0.00
0.000.00
46.00 7.37 9.84
0.00
102.00 776.88
559657836
0.00
6.70
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
534.88
61893
Other Deduction Detail: SDI: 6.70
Male
69.83
1126.38
Indio, CA 92201
81921 Victoria St.
Fringe Detail: Administrative Fund: $0.121/$0.06, Pension: $16.968/$8.40, Annuity: $1.01/$0.50, Vacation: $9.837/$4.87, Contract Compliance: $0.606/$0.30, Indust. Stab.Fund: $0.242/$0.12, Health & Welfare: $15.089/$7.47,
Training Fund: $1.394/$0.69
0
0Landscape Irrigation
Labor
0
Gerardo Saldivar Mejia
S
D 0
0
00000
0 02.02 0 0 33.432.02
0.00
0.00
0.000.00
100.00 20.48 16.34
0.00
217.92 908.46
607068060
0.00
11.27
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
67.52
61878
Other Deduction Detail: SDI: 11.27
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
12.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/04/2020 2016-08/2016-08
29 30 31 1 2 3 4
Medicare
SUN MON TUE WED THU FRI SAT
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.
56.69
914.34
Thermal, CA 92274
56725 Harrison St.
Fringe Detail: Annuity: $1.01/$0.50, Pension: $16.968/$8.40, Contract Compliance: $0.606/$0.30, Vacation: $9.837/$4.87, Administrative Fund: $0.121/$0.06, Training Fund: $1.394/$0.69, Indust. Stab.Fund: $0.242/$0.12,
Health & Welfare: $15.089/$7.47
0
0Landscape Irrigation
Labor
0
Rafael Sanchez Garcia
S
D 0
0
00000
0 02.02 0 0 33.432.02
0.00
0.00
0.000.00
75.00 12.55 13.26
0.00
166.64 747.70
614126878
0.00
9.14
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
67.52
61908
Other Deduction Detail: SDI: 9.14
Male Hispanic American
58.82
948.70
Thermal, CA 92274
55550 Tyler St. Space #3
Fringe Detail: Health & Welfare: $121.238/$7.47, Pension: $136.332/$8.40, Vacation: $79.04/$4.87, Training Fund: $11.199/$0.69, Annuity: $8.115/$0.50, Contract Compliance: $4.869/$0.30, Administrative Fund: $0.974/$0.06,
Indust. Stab.Fund: $1.948/$0.12
0
0Landscape Irrigation
Labor
4
Miguel L. Sanchez
S
D 0
8.00
00000
0 08.00 0 0 33.4316.00
0.00
0.00
0.000.00
62.00 21.89 13.76
0.00
165.96 782.74
622987861
0.00
9.49
1)
2)
3)O 0 0 0 0 0 0.23 0 0.23 50.14 0.00
546.41
61900
Other Deduction Detail: SDI: 9.49
Male
36.70
592.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $131.68/$8.23, Health & Welfare: $119.52/$7.47, Pension: $134.40/$8.40, Annuity: $8.00/$0.50, Training Fund: $11.04/$0.69, Contract Compliance: $4.80/$0.30, Indust. Stab.Fund: $1.28/$0.08,
Administrative Fund: $0.96/$0.06, Other: $1.12/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
8.00
00000
0 8.0000 0 37.0016.00
0.00
0.00
0.000.00
49.00 8.93 8.58
0.00
109.13 482.87
529802418
0.00
5.92
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
592.00
61880
Other Deduction Detail: SDI: 5.92
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
12.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/04/2020 2016-08/2016-08
29 30 31 1 2 3 4
Medicare
SUN MON TUE WED THU FRI SAT
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 #12.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
29th
President
January 16th, 2020
Urban Habitat
2019 20202020December4th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, SDI, State Tax
Lien
45.88
740.00
Riverside, CA 92507
4046 Dwight Ave.
Fringe Detail: Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Pension: $164.00/$4.10, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08, Administrative Fund: $2.40/$0.06, Health & Welfare: $176.
00/$4.40, Vacation: $49.60/$1.24
0
0Cement Mason
3
Josue Arce
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 18.5040.00
0.00
0.00
0.000.00
46.00 10.70 10.73
0.00
120.71 619.29
611506098
0.00
7.40
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
740.00
Apprentice Level 1 61942
Other Deduction Detail: SDI: 7.40
Male Hispanic American
64.83
1045.59
Apple Valley, CA 92307
20715 Stoddard Wells Rd.
Fringe Detail: Health & Welfare: $37.35/$7.47, Pension: $42.00/$8.40, Annuity: $2.50/$0.50, Vacation: $24.35/$4.87, Training Fund: $3.45/$0.69, Contract Compliance: $1.50/$0.30, Administrative Fund: $0.30/$0.06, Indust.
Stab.Fund: $0.60/$0.12
0
0Landscape Irrigation
Labor
4
Daniel J. Carver
S
D 0
0
00000
3.50 1.5000 0 35.435.00
0.00
0.00
0.000.00
51.00 6.60 15.16
0.00
148.04 897.55
270717343
0.00
10.45
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
177.15
61921
Other Deduction Detail: SDI: 10.45
Male Caucasian
91.76
1480.00
Palm Desert, CA 92260
5 Running H
Fringe Detail: Vacation: $329.20/$8.23, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08,
Other: $2.80/$0.07, Administrative Fund: $2.40/$0.06
0
0Cement Mason
2
Luis M. Castaneda
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 37.0040.00
0.00
0.00
0.000.00
123.00 31.72 21.46
0.00
469.31 1010.69
547439373
0.00
201.37
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1480.00
61946
Other Deduction Detail: SDI: 201.37
Male
72.84
1174.86
Apple Valley, CA 92308
20250 Itasca Rd.
Fringe Detail: Health & Welfare: $49.35/$9.87, Pension: $49.35/$9.87, Vacation: $24.20/$4.84, Training Fund: $7.50/$1.50, Annuity: $1.25/$0.25, Contract Compliance: $1.50/$0.30, Administrative Fund: $0.30/$0.06, Indust.
Stab.Fund: $0.60/$0.12
0
0Landscape Oper. Eng
2
Cameron D. Cleland
S
D 0
0
00000
3.50 1.5000 0 38.455.00
0.00
0.00
0.000.00
86.00 17.45 17.04
0.00
205.08 969.78
565931366
0.00
11.75
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
192.25
61918
Other Deduction Detail: SDI: 11.75
Male Caucasian
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
13.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/11/2020 2016-08/2016-08
5 6 7 8 9 10 11
Medicare
SUN MON TUE WED THU FRI SAT
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.
57.30
924.14
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $26.145/$7.47, Pension: $29.40/$8.40, Annuity: $1.75/$0.50, Vacation: $17.045/$4.87, Training Fund: $2.415/$0.69, Contract Compliance: $1.05/$0.30, Administrative Fund: $0.21/$0.06,
Indust. Stab.Fund: $0.42/$0.12
0
0Landscape Irrigation
Labor
0
Kenneth P. Ocean
S
D 0
0
00000
3.50 000 0 33.433.50
0.00
0.00
0.000.00
76.00 12.76 13.40
0.00
168.70 755.44
559657836
0.00
9.24
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
117.00
61944
Other Deduction Detail: SDI: 9.24
Male
57.30
924.14
Hesperia, CA 92345
15214 Mission St.
Fringe Detail: Health & Welfare: $11.205/$7.47, Vacation/ Holiday: $7.305/$4.87, Pension: $13.35/$8.90, Training Fund: $1.035/$0.69, Other: $0.915/$0.61
0
0Laborer: Group 2
0
Kenneth P. Ocean
S
D 0
0
00000
0 1.5000 0 35.791.50
0.00
0.00
0.000.00
76.00 12.76 13.40
0.00
168.70 755.44
559657836
0.00
9.24
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
53.68
61944
Other Deduction Detail: SDI: 9.24
Male
91.76
1480.00
Indio, CA 92203
81797 Avenida Estuco
Fringe Detail: Vacation: $329.20/$8.23, Health & Welfare: $298.80/$7.47, Pension: $336.00/$8.40, Annuity: $20.00/$0.50, Training Fund: $27.60/$0.69, Contract Compliance: $12.00/$0.30, Indust. Stab.Fund: $3.20/$0.08,
Administrative Fund: $2.40/$0.06, Other: $2.80/$0.07
0
0Cement Mason
1
Howard A. Turnbow
S
D 0
8.00
00000
8.00 8.008.00 8.00 0 37.0040.00
0.00
0.00
0.000.00
210.00 80.00 21.46
0.00
418.02 1061.98
529802418
0.00
14.80
1)
2)
3)O 0 0 0 0 0 0 0 0.00 0.00 0.00
1480.00
61931
Other Deduction Detail: SDI: 14.80
Male
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 DTUrban Habitat
PO Box 1177
La Quinta, CA 92247
13.1 La Quinta SilverRock Park Venue
La Quinta SilverRock Resort01/11/2020 2016-08/2016-08
5 6 7 8 9 10 11
Medicare
SUN MON TUE WED THU FRI SAT
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 #13.1,
Contractor License # 963744, Workers Compensation Policy # URWC004126
Urban Habitat
5th
President
January 22nd, 2020
Urban Habitat
2020 20202020January11th
-
* 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 ElectronicallyTheresa Brennan, President
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 ,
Theresa Brennan
(Contractor or Subcontractor)
La Quinta SilverRock Resort
(Name of Signatory Party)(Title)
(c) EXCEPTIONS
FICA, FWH, Medicare, State Tax, SDI