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Urban_Habitat__72.0_2-27-217.93 128.00 Coachella, CA 92236 84711 Ave 51 Fringe Detail: Health & Welfare: $21.20/$2.65, Pension: $8.00/$1.00, Annuity: $2.80/$0.35, Vacation: $8.24/$1.03 0 0Landscape Irr. Tender 3 Alejandro Aguayo S D 0 0 00000 0 08.00 0 0 16.008.00 0.00 0.00 0.000.00 0.00 0.00 1.86 0.00 11.33 116.67 616926918 0.00 1.54 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 128.00 65183 Other Deduction Detail: SDI: 1.54 Male Hispanic American 36.29 585.28 Ontario, CA 91762 1015 W. Flora St. Fringe Detail: Annuity: $14.56/$0.91, Training Fund: $11.20/$0.70, Health & Welfare: $128.00/$8.00, Pension: $134.40/$8.40, Vacation: $77.92/$4.87, Contract Compliance: $4.80/$0.30, Administrative Fund: $0.96/$0.06, Indust. Stab.Fund: $1.92/$0.12 0 0Landscape Irrigation Labor 0 Espiridion Bautista S D 0 0 00000 0 08.00 8.00 0 34.5816.00 0.00 0.00 0.000.00 28.00 8.39 8.48 0.00 88.18 497.10 673039037 0.00 7.02 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 553.28 65194 Other Deduction Detail: SDI: 7.02 Male Hispanic American 85.76 1383.20 Temecula, CA 92592 30240 Miraloma Dr. Fringe Detail: Annuity: $14.56/$0.91, Training Fund: $11.20/$0.70, Administrative Fund: $0.96/$0.06, Indust. Stab.Fund: $1.92/$0.12, Contract Compliance: $4.80/$0.30, Vacation: $77.92/$4.87, Health & Welfare: $134. 40/$8.40, Pension: $128.00/$8.00 0 0Landscape Irrigation Labor 0 Oscar Diaz S D 0 0 00000 0 08.00 8.00 0 34.5816.00 0.00 0.00 0.000.00 52.00 66.46 20.06 0.00 534.07 849.13 615121373 0.00 309.79 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 553.28 65228 Other Deduction Detail: SDI: 16.60, State Tax Lien: 293.19 Male Hispanic American 57.07 920.51 Coachella, CA 92236 84711 Ave. 51 Fringe Detail: Annuity: $7.28/$0.91, Health & Welfare: $64.00/$8.00, Pension: $67.20/$8.40, Vacation/ Holiday: $38.96/$4.87, Administrative Fund: $0.48/$0.06, Contract Compliance: $2.40/$0.30, Training Fund: $5.60/$0.70, Indust. Stab.Fund: $0.96/$0.12 0 0Landscape Irrigation Labor 2 Marco A. Garcia Alonso S D 0 0 00000 8.00 000 0 36.588.00 0.00 0.00 0.000.00 55.00 7.33 13.35 0.00 143.80 776.71 641513170 0.00 11.05 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 292.64 65217 Other Deduction Detail: SDI: 11.05 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. 57.07 920.51 Coachella, CA 92236 84711 Ave. 51 Fringe Detail: Annuity: $11.20/$0.35, Health & Welfare: $84.80/$2.65, Vacation/ Holiday: $32.96/$1.03, Pension: $32.00/$1.00 0 0Landscape Irr. Tender 2 Marco A. Garcia Alonso S D 0 8.00 00000 0 8.008.00 8.00 0 18.0032.00 0.00 0.00 0.000.00 55.00 7.33 13.35 0.00 143.80 776.71 641513170 0.00 11.05 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 576.00 65217 Other Deduction Detail: SDI: 11.05 Male Hispanic American 103.22 1664.80 Indio, CA 92203 41345 Noyes Crt. Fringe Detail: Vacation: $305.20/$7.63, Health & Welfare: $320.00/$8.00, Pension: $336.00/$8.40, Annuity: $36.40/$0.91, Training Fund: $28.00/$0.70, 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 0 Ruben Gonzalez S D 0 8.00 00000 8.00 8.008.00 8.00 0 38.5040.00 0.00 0.00 0.000.00 0.00 25.37 24.14 0.00 172.71 1492.09 608268512 0.00 19.98 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1540.00 65233 Other Deduction Detail: SDI: 19.98 Male Hispanic American 52.83 852.00 San Jacinto, CA 92583 258 W. 7th St., Spc. 80 Fringe Detail: Annuity: $10.00/$0.25, Training Fund: $66.40/$1.66, Pension: $178.80/$4.47, Health & Welfare: $180.00/$4.50, Administrative Fund: $2.40/$0.06, Indust. Stab.Fund: $3.20/$0.08, Contract Compliance: $12. 00/$0.30, Vacation: $50.40/$1.26 0 0Landscape Irrigation Labor 0 Jose Gutierrez S D 0 8.00 00000 8.00 8.008.00 8.00 0 21.3040.00 0.00 0.00 0.000.00 0.00 0.58 12.35 0.00 75.98 776.02 571210268 0.00 10.22 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 852.00 Apprentice Level 2 65209 Other Deduction Detail: SDI: 10.22 Male Hispanic American 95.48 1540.00 Coachella, CA 92236 85687 Guadalupana Ct. Fringe Detail: Health & Welfare: $330.80/$8.27, Pension: $394.40/$9.86, Vacation: $285.76/$7.144, Training Fund: $25.60/$0.64, Other: $9.60/$0.24 0 0Cement Mason 0 Jose A. Lagunes Medina S D 0 8.00 00000 8.00 8.008.00 8.00 0 38.5040.00 0.00 0.00 0.000.00 0.00 36.07 22.33 0.00 172.36 1367.64 805817125 0.00 18.48 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1540.00 65205 Other Deduction Detail: SDI: 18.48 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. 9548.00 1540.00 Coachella, CA 92236 49072 Brianne Lane Fringe Detail: Vacation: $305.20/$7.63, Health & Welfare: $320.00/$8.00, Pension: $336.00/$8.40, Annuity: $36.40/$0.91, Training Fund: $28.00/$0.70, Cooperation Comm.: $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 0 Daniel A. Ochoa S D 0 8.00 00000 8.00 8.008.00 8.00 0 38.5040.00 0.00 0.00 0.000.00 111.00 43.94 22.33 0.00 9743.75 -8203.75 609984392 0.00 18.48 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1540.00 65190 Other Deduction Detail: SDI: 18.48 Male Hispanic American 36.95 602.25 Coachella, CA 92236 85473 Avenida Maria Fringe Detail: Annuity: $1.487/$0.35, Pension: $4.25/$1.00, Health & Welfare: $11.262/$2.65, Vacation: $4.378/$1.03 0 0Landscape Irr. Tender 4 Jose Ortiz Navarro S D 0 0 00000 4.25 000 0 15.534.25 0.00 0.00 0.000.00 0.00 6.24 8.64 0.00 70.80 531.45 609459676 0.00 18.97 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 66.00 65211 Other Deduction Detail: SDI: 2.15, Dental and Vision: 16.82 Male 36.24 584.38 Cathedral City, CA 92234 47648 Seville St. Fringe Detail: Vacation: $4.378/$1.03, Pension: $4.25/$1.00, Health & Welfare: $11.262/$2.65, Annuity: $1.487/$0.35 0 0Landscape Irr. Tender 0 Marco A. Ortiz S D 0 0 00000 4.25 000 0 15.534.25 0.00 0.00 0.000.00 37.00 10.97 8.47 0.00 99.69 484.69 602413293 0.00 7.01 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 66.00 65216 Other Deduction Detail: SDI: 7.01 Male Hispanic American 35.08 582.84 Desert Hot Springs, CA 92240 15225 Palm Drive Space #11 Fringe Detail: Vacation: $2.833/$1.03, Pension: $2.75/$1.00, Annuity: $0.962/$0.35, Health & Welfare: $7.287/$2.65 0 0Landscape Irr. Tender 1 Guadalupe Pacheco S D 0 0 00000 2.75 000 0 15.532.75 0.00 0.00 0.000.00 25.00 4.10 8.21 0.00 96.20 486.64 579481023 0.00 23.81 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 42.70 65198 Other Deduction Detail: SDI: 6.99, Dental and Vision: 16.82 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. 36.95 587.21 Indio, CA 92201 80963 Granby S Fringe Detail: Health & Welfare: $25.837/$2.65, Pension: $9.75/$1.00, Vacation: $10.043/$1.03, Annuity: $3.412/$0.35 0 0Landscape Irr. Tender 0 Jose I. Perez Cintora S D 0 1.50 00000 2.50 1.751.25 2.75 0 17.009.75 0.00 0.00 0.000.00 0.00 6.24 8.64 0.00 231.29 355.92 554654056 0.00 179.46 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 165.75 65185 Other Deduction Detail: SDI: 8.17, Child Support: 86.54, Child Support Fee: 1.50, Med/Dental/Vision Ins: 83.25 Male 95.48 1540.00 Coachella, CA 92236 52821 Calle Joyce Fringe Detail: Vacation: $305.20/$7.63, Health & Welfare: $320.00/$8.00, Pension: $336.00/$8.40, Annuity: $36.40/$0.91, Training Fund: $28.00/$0.70, 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 0 Jesus J. Perez Vazquez S D 0 8.00 00000 8.00 8.008.00 8.00 0 38.5040.00 0.00 0.00 0.000.00 23.00 29.49 22.33 0.00 188.78 1351.22 607900677 0.00 18.48 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1540.00 65204 Other Deduction Detail: SDI: 18.48 Male Hispanic American 36.41 587.21 Indio, CA 92201 45903 Deglet Noor Fringe Detail: Pension: $7.00/$1.00, Vacation: $7.21/$1.03, Health & Welfare: $18.55/$2.65, Annuity: $2.45/$0.35 0 0Landscape Irr. Tender 0 Blanca Perez S D 0 1.50 00000 2.75 002.75 0 15.537.00 0.00 0.00 0.000.00 0.00 0.00 8.51 0.00 51.96 535.25 582192373 0.00 7.04 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 108.71 65185 Other Deduction Detail: SDI: 7.04 Female Hispanic American 97.66 1540.00 Riverside, CA 92509 9247 52nd St. Fringe Detail: Administrative Fund: $1.92/$0.12, Training Fund: $11.20/$0.70, Annuity: $14.56/$0.91, Indust. Stab.Fund: $0.96/$0.06, Contract Compliance: $4.80/$0.30, Health & Welfare: $128.00/$8.00, Pension: $134. 40/$8.40, Vacation: $77.92/$4.87 0 0Landscape Irrigation Labor 3 Israel Rincon Garcia S D 0 0 00000 0 08.00 8.00 0 34.5816.00 0.00 0.00 0.000.00 61.00 39.17 22.84 0.00 239.57 1300.43 610134793 0.00 18.90 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 553.28 65199 Other Deduction Detail: SDI: 18.90 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. 114.42 1845.52 Indio, CA 92201 81921 Victoria St. Fringe Detail: Administrative Fund: $0.735/$0.06, Pension: $102.90/$8.40, Annuity: $11.148/$0.91, Vacation: $59.657/$4.87, Contract Compliance: $3.675/$0.30, Indust. Stab.Fund: $1.47/$0.12, Health & Welfare: $98.00/$8.00, Training Fund: $8.575/$0.70 0 0Landscape Irrigation Labor 0 Gerardo Saldivar Mejia S D 0 4.25 00000 0 8.0000 0 36.5812.25 0.00 0.00 0.000.00 191.00 75.36 26.76 0.00 429.68 1415.84 607068060 0.00 22.14 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 448.10 65197 Other Deduction Detail: SDI: 22.14 Male Hispanic American 111.35 1796.00 Lake Elsinore, CA 92530 15212 Lincoln St. #A Fringe Detail: Training Fund: $40.00/$1.00, Pension: $426.00/$10.65, Health & Welfare: $458.00/$11.45, Vacation/ Holiday: $142.00/$3.55, Other: $6.00/$0.15 0 0Landscape Oper. Eng 0 Jose D. Sandoval Becerra S D 0 8.00 00000 8.00 8.008.00 8.00 0 38.4540.00 0.00 0.00 0.000.00 63.00 49.01 26.04 0.00 270.96 1525.04 612336635 0.00 21.56 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1538.00 65208 Other Deduction Detail: SDI: 21.56 Male Hispanic American 31.74 512.00 Lake Elsinore, CA 92530 15212 Lincoln St. #A Fringe Detail: Annuity: $11.20/$0.35, Pension: $32.00/$1.00, Vacation: $32.96/$1.03, Health & Welfare: $84.80/$2.65 0 0Landscape Irr. Tender 0 Jose A. Sandoval S D 0 0 00000 8.00 8.008.00 8.00 0 16.0032.00 0.00 0.00 0.000.00 29.00 7.79 7.42 0.00 82.09 429.91 603024821 0.00 6.14 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 512.00 65206 Other Deduction Detail: SDI: 6.14 Male Hispanic American 15.87 256.00 Ontario, CA 91762 1015 W. Flora St. Fringe Detail: Vacation: $16.48/$1.03, Pension: $16.00/$1.00, Health & Welfare: $42.40/$2.65, Annuity: $5.60/$0.35 0 0Landscape Irr. Tender 0 Enrique Santana S D 0 0 00000 0 08.00 8.00 0 16.0016.00 0.00 0.00 0.000.00 0.00 0.00 3.71 0.00 22.65 233.35 611235342 0.00 3.07 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 256.00 65193 Other Deduction Detail: SDI: 3.07 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. 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 72.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort02/27/2021 2016-08/2016-08 21 22 23 24 25 26 27 Medicare SUN MON TUE WED THU FRI SAT CA-SC-UHWage Det: Check No. Sex Race 38.45 620.13 Palm Springs, CA 92262 2950 N. Indian Fringe Detail: Vacation: $4.378/$1.03, Pension: $4.25/$1.00, Health & Welfare: $11.262/$2.65, Annuity: $1.487/$0.35 0 0Landscape Irr. Tender 0 Jose Sarabia S D 0 0 00000 4.25 000 0 15.534.25 0.00 0.00 0.000.00 32.00 9.92 8.99 0.00 96.80 523.33 609063372 0.00 7.44 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 66.00 65207 Other Deduction Detail: SDI: 7.44 Male Hispanic American 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. This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved. Contract #2016-08, Wage Decision #CA-SC-UH Mod 0 10/01/19,Payroll #72, Contractor License # 963744, Workers Compensation Policy # URWC104739 Urban Habitat 21st Other March 11th, 2021 Urban Habitat 2021 2021FebruaryFebruary27th - * 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, Other 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 Park Venue (Name of Signatory Party)(Title) (c) EXCEPTIONS FICA, FWH, Medicare, State Tax, Child Support, Child Support Fee, Dental and Vision, Med/Dental/Vision Ins, SDI, State Tax Lien This document was created using an EVALUATION version of ActiveReports. Only a licensed user may legally create reports for use in production. Please report infractions or address questions to sales@grapecity.us.com. Copyright © 2002-2009 GrapeCity, inc. All rights reserved.