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Urban_Habitat__77.0_4-3-2124.60 396.64 Thermal, CA 92274 55550 Tyler St. Fringe Detail: Training Fund: $11.36/$1.42, Annuity: $4.08/$0.51, Pension: $67.20/$8.40, Contract Compliance: $2.40/$0.30, Indust. Stab.Fund: $0.64/$0.08, Administrative Fund: $0.48/$0.06, Health & Welfare: $59.76/$7.47, Vacation: $10.64/$1.33 0 0Landscape Irrigation Labor 5 Maurilio P. Cortez S D 0 8.00 00000 0 000 0 24.798.00 0.00 0.00 0.000.00 0.00 0.00 5.75 0.00 35.11 361.53 604521749 0.00 4.76 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 198.32 Apprentice Level 3 65463 Other Deduction Detail: SDI: 4.76 Male Hispanic American 42.82 690.64 Coachella, CA 92236 84711 Ave. 51 Fringe Detail: Annuity: $6.30/$0.35, Health & Welfare: $47.70/$2.65, Vacation/ Holiday: $18.54/$1.03, Pension: $18.00/$1.00 0 0Landscape Irr. Tender 2 Marco A. Garcia Alonso S D 0 7.00 00000 3.00 008.00 0 18.0018.00 0.00 0.00 0.000.00 29.00 2.28 10.01 0.00 92.40 598.24 641513170 0.00 8.29 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 324.00 65461 Other Deduction Detail: SDI: 8.29 Male Hispanic American 42.82 690.64 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 0 08.00 0 0 36.588.00 0.00 0.00 0.000.00 29.00 2.28 10.01 0.00 92.40 598.24 641513170 0.00 8.29 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 292.64 65461 Other Deduction Detail: SDI: 8.29 Male Hispanic American 68.60 1106.56 Indio, CA 92203 41345 Noyes Crt. Fringe Detail: Annuity: $29.12/$0.91, Administrative Fund: $1.92/$0.06, Indust. Stab.Fund: $3.84/$0.12, Contract Compliance: $9.60/$0.30, Training Fund: $22.40/$0.70, Vacation: $155.84/$4.87, Health & Welfare: $256. 00/$8.00, Pension: $268.80/$8.40 0 0Landscape Irrigation Labor 0 Ruben Gonzalez S D 0 8.00 00000 8.00 8.0008.00 0 34.5832.00 0.00 0.00 0.000.00 0.00 8.71 16.04 0.00 106.63 999.93 608268512 0.00 13.28 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 1106.56 65000475 Other Deduction Detail: SDI: 13.28 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 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. 31.37 505.88 San Jacinto, CA 92583 258 W. 7th St., Spc. 80 Fringe Detail: Annuity: $5.875/$0.25, Training Fund: $39.01/$1.66, Pension: $105.045/$4.47, Health & Welfare: $105.75/$4.50, Administrative Fund: $1.41/$0.06, Indust. Stab.Fund: $1.88/$0.08, Contract Compliance: $7. 05/$0.30, Vacation: $29.61/$1.26 0 0Landscape Irrigation Labor 0 Jose Gutierrez S D 0 7.00 00000 8.00 008.00 0 21.3023.00 0.00 0.00 0.000.00 0.00 0.00 7.34 0.00 44.78 461.10 571210268 0.00 6.07 1) 2) 3)O 0 0 0.50 0 0 0 0 0.50 31.96 0.00 505.88 Apprentice Level 2 65456 Other Deduction Detail: SDI: 6.07 Male Hispanic American 52.82 852.00 Desert Hot Springs, CA 92240 66886 Camino Idilio Fringe Detail: Health & Welfare: $219.84/$9.16, Pension: $9.12/$0.38, Training Fund: $33.84/$1.41, Other: $25.68/$1.07 0 0Landscape Irrigation Labor 4 Luis F. Lopez Quintero S D 0 8.00 00000 8.00 8.0000 0 21.3024.00 0.00 0.00 0.000.00 50.00 22.78 12.35 0.00 148.17 703.83 164777350 0.00 10.22 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 511.20 Apprentice Level 2 65460 Other Deduction Detail: SDI: 10.22 Male 25.30 408.00 Thermal, CA 92274 55550 Tyler St. Space #3 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 5 Juan LopezMendez S D 0 0 00000 0 8.0000 0 17.008.00 0.00 0.00 0.000.00 0.00 0.00 5.92 0.00 36.12 371.88 620099088 0.00 4.90 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 136.00 65459 Other Deduction Detail: SDI: 4.90 Male 80.77 1302.80 Desert Hot Springs, CA 92240 66886 Camino Idilio Fringe Detail: Health & Welfare: $128.00/$8.00, Pension: $134.40/$8.40, Annuity: $14.56/$0.91, Vacation: $77.92/$4.87, Training Fund: $11.20/$0.70, 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 0 00000 8.00 8.0000 0 34.5816.00 0.00 0.00 0.000.00 71.00 16.39 18.89 0.00 202.68 1100.12 604137146 0.00 15.63 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 553.28 65446 Other Deduction Detail: SDI: 15.63 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 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. 80.77 1302.80 Desert Hot Springs, CA 92240 66886 Camino Idilio Fringe Detail: Health & Welfare: $64.00/$8.00, Pension: $67.20/$8.40, Annuity: $7.28/$0.91, Vacation: $38.96/$4.87, Training Fund: $5.60/$0.70, Contract Compliance: $2.40/$0.30, Administrative Fund: $0.48/$0.06, Indust. Stab.Fund: $0.96/$0.12 0 0Landscape Irrigation Labor 5 Felipe Lopez S D 0 8.00 00000 0 000 0 36.588.00 0.00 0.00 0.000.00 71.00 16.39 18.89 0.00 202.68 1100.12 604137146 0.00 15.63 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 292.64 65446 Other Deduction Detail: SDI: 15.63 Male 38.69 632.57 Coachella, CA 92236 85473 Avenida Maria Fringe Detail: Annuity: $6.65/$0.35, Pension: $19.00/$1.00, Health & Welfare: $50.35/$2.65, Vacation: $19.57/$1.03 0 0Landscape Irr. Tender 4 Jose Ortiz Navarro S D 0 0 00000 6.25 08.00 4.75 0 15.5319.00 0.00 0.00 0.000.00 6.00 0.00 9.04 0.00 69.73 562.84 609459676 0.00 16.00 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 295.07 65457 Other Deduction Detail: SDI: 16.00 Male 39.09 639.02 Desert Hot Springs, CA 92240 15225 Palm Drive Space #11 Fringe Detail: Vacation: $4.635/$1.03, Pension: $4.50/$1.00, Annuity: $1.575/$0.35, Health & Welfare: $11.925/$2.65 0 0Landscape Irr. Tender 1 Guadalupe Pacheco S D 0 0 00000 4.50 000 0 15.534.50 0.00 0.00 0.000.00 31.00 5.52 9.14 0.00 100.83 538.19 579481023 0.00 16.08 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 69.88 65449 Other Deduction Detail: SDI: 16.08 Male 48.48 782.02 Riverside, CA 92509 9247 52nd St. Fringe Detail: Administrative Fund: $1.32/$0.12, Training Fund: $7.70/$0.70, Annuity: $10.01/$0.91, Indust. Stab.Fund: $0.66/$0.06, Contract Compliance: $3.30/$0.30, Health & Welfare: $88.00/$8.00, Pension: $92.40/$8.40, Vacation: $53.57/$4.87 0 0Landscape Irrigation Labor 4 Israel Rincon Garcia S D 0 0 00000 3.00 008.00 0 34.5811.00 0.00 0.00 0.000.00 0.00 0.00 11.34 0.00 69.21 712.81 610134793 0.00 9.39 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 380.38 65450 Other Deduction Detail: SDI: 9.39 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 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. 41.91 584.64 Coachella, CA 92236 84047 Fiesta Rd. Fringe Detail: Health & Welfare: $11.925/$2.65, Pension: $4.50/$1.00, Vacation: $4.50/$1.00, Annuity: $1.575/$0.35 0 0Landscape Irr. Tender 6 Miguel Roman S D 0 0 00000 4.50 000 0 16.004.50 0.00 0.00 0.000.00 68.00 15.00 9.80 0.00 142.82 441.82 607120965 0.00 8.11 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 72.00 65000469 Other Deduction Detail: SDI: 8.11 Male 77.11 1243.68 Indio, CA 92201 81921 Victoria St. Fringe Detail: Administrative Fund: $1.44/$0.06, Pension: $201.60/$8.40, Annuity: $21.84/$0.91, Vacation: $116.88/$4.87, Contract Compliance: $7.20/$0.30, Indust. Stab.Fund: $2.88/$0.12, Health & Welfare: $192.00/$8.00, Training Fund: $16.80/$0.70 0 0Landscape Irrigation Labor 0 Gerardo Saldivar Mejia S D 0 0 00000 8.00 8.0008.00 0 36.5824.00 0.00 0.00 0.000.00 113.00 25.60 18.03 0.00 248.67 995.01 607068060 0.00 14.93 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 877.92 65448 Other Deduction Detail: SDI: 14.93 Male Hispanic American 77.11 1243.68 Indio, CA 92201 81921 Victoria St. Fringe Detail: Administrative Fund: $0.27/$0.06, Pension: $37.80/$8.40, Annuity: $4.095/$0.91, Vacation: $21.915/$4.87, Contract Compliance: $1.35/$0.30, Indust. Stab.Fund: $0.54/$0.12, Health & Welfare: $36.00/$8.00, Training Fund: $3.15/$0.70 0 0Landscape Irrigation Labor 0 Gerardo Saldivar Mejia S D 0 4.00 00000 0 000 0 34.584.00 0.00 0.00 0.000.00 113.00 25.60 18.03 0.00 248.67 995.01 607068060 0.00 14.93 1) 2) 3)O 0 0 0.50 0 0 0 0 0.50 54.88 0.00 165.76 65448 Other Deduction Detail: SDI: 14.93 Male Hispanic American 42.39 683.64 Thermal, CA 92274 56725 Harrison St. Fringe Detail: Health & Welfare: $60.95/$2.65, Pension: $23.00/$1.00, Vacation: $23.69/$1.03, Annuity: $8.05/$0.35 0 0Landscape Irr. Tender 0 Rafael Sanchez Garcia S D 0 7.00 00000 8.00 008.00 0 17.0023.00 0.00 0.00 0.000.00 46.00 7.37 9.91 0.00 113.88 569.76 614126878 0.00 8.21 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 391.00 65473 Other Deduction Detail: SDI: 8.21 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 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. 42.39 683.64 Thermal, CA 92274 56725 Harrison St. Fringe Detail: Annuity: $7.28/$0.91, Pension: $67.20/$8.40, Contract Compliance: $2.40/$0.30, Vacation: $38.96/$4.87, Administrative Fund: $0.48/$0.06, Training Fund: $5.60/$0.70, Indust. Stab.Fund: $0.96/$0.12, Health & Welfare: $64.00/$8.00 0 0Landscape Irrigation Labor 0 Rafael Sanchez Garcia S D 0 0 00000 0 08.00 0 0 36.588.00 0.00 0.00 0.000.00 46.00 7.37 9.91 0.00 113.88 569.76 614126878 0.00 8.21 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 292.64 65473 Other Deduction Detail: SDI: 8.21 Male Hispanic American 76.85 1239.50 Thermal, CA 92274 55550 Tyler St. Space #3 Fringe Detail: Health & Welfare: $192.00/$8.00, Pension: $201.60/$8.40, Vacation: $116.88/$4.87, Training Fund: $16.80/$0.70, Annuity: $21.84/$0.91, Contract Compliance: $7.20/$0.30, Administrative Fund: $1.44/$0.06, Indust. Stab.Fund: $2.88/$0.12 0 0Landscape Irrigation Labor 5 Miguel L. Sanchez S D 0 8.00 00000 8.00 8.0000 0 34.5824.00 0.00 0.00 0.000.00 101.00 46.52 17.97 0.00 257.21 982.29 622987861 0.00 14.87 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 829.92 65464 Other Deduction Detail: SDI: 14.87 Male 38.46 620.34 Palm Springs, CA 92262 2950 N. Indian Fringe Detail: Vacation: $11.33/$1.03, Pension: $11.00/$1.00, Health & Welfare: $29.15/$2.65, Annuity: $3.85/$0.35 0 0Landscape Irr. Tender 0 Jose Sarabia S D 0 0 00000 6.25 004.75 0 15.5311.00 0.00 0.00 0.000.00 32.00 9.93 9.00 0.00 96.83 523.51 609063372 0.00 7.44 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 170.83 65455 Other Deduction Detail: SDI: 7.44 Male Hispanic American 36.25 584.64 Indio, CA 92201 82388 Rebecca Dr. Fringe Detail: Health & Welfare: $11.925/$2.65, Pension: $4.50/$1.00, Vacation: $4.635/$1.03, Annuity: $1.575/$0.35 0 0Landscape Irr. Tender 6 Norberto Vasquez Santiago S D 0 0 00000 4.50 000 0 15.534.50 0.00 0.00 0.000.00 0.00 0.00 8.47 0.00 51.74 532.90 622506325 0.00 7.02 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 69.88 65469 Other Deduction Detail: SDI: 7.02 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 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 77.0 La Quinta SilverRock Park Venue La Quinta SilverRock Resort04/03/2021 2016-08/2016-08 28 29 30 31 1 2 3 Medicare SUN MON TUE WED THU FRI SAT CA-SC-UHWage Det: Check No. Sex Race 38.25 616.96 Indio, CA 92201 47598 Calle Diamante Fringe Detail: Health & Welfare: $36.875/$2.50, Annuity: $5.162/$0.35, Pension: $14.75/$1.00, Vacation: $15.193/$1.03 0 0Landscape Irr. Tender 2 Ivan Zavala Zavala S D 0 0 00000 2.00 08.00 4.75 0 15.5314.75 0.00 0.00 0.000.00 22.00 0.65 8.95 0.00 77.25 539.71 608547170 0.00 7.40 1) 2) 3)O 0 0 0 0 0 0 0 0.00 0.00 0.00 229.06 65451 Other Deduction Detail: SDI: 7.40 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. 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 #77, Contractor License # 963744, Workers Compensation Policy # URWC104739 Urban Habitat 28th Other April 14th, 2021 Urban Habitat 2021 2021AprilMarch3rd - * 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, SDI 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.