Bowers.Bijou CP 3-11_Redacted Depa411R rtment
California 2022 Bowers&Bijou Zf3 Waterline Replacement Project I 20.30.6f94 and 20.39.8267
Departrnent of J R 1
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of
NAME OF CONTRACTOR:Vinciguerra Construction.Inc. CONTRACTOR'S LICENSE NO.:358838 ADDRESS:P.D.Box 157.Suxer Creek,CA,95635
IOR SUBCONTRACTOR' SPECIALTY LICENSE NO.:
'PAYROLL NO. FOR WEEK ENDING: SELF-INSURED CERT: PROJECTOR CONTRACT NO.:20.30.8994 and 20.39.8281
3 51712022 'ArORKERS'COMP: PROJECT AND LOCATION;2022 Bowers&Bijou 213 Waterline Replacement Proje , BUD
(1) (2) I (3) (4).DAY (5) (6) (7) (8) (g?
S 14 T W T F S
�N � NEI
NAME,ADDRESS a WORK Dale HOURLY WAGES
AND SOCIAL j TOTAL GROSS AMOUNT CHECK
SECURITY NUMBER za CLASS- - RATE DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID
aHOURS EARNED
OF EMPLOYEE v I IFICATION 5/01 5102 5103 5iO4 5105 5106 5107 OF PAY FOR NO.
£ WEEK
Hours Worked Each Day
r THIS ALL Federal FICA& State Vacation Health&
S 0.00 0.00 8.00 0.00 8.00 8.00 0.00 24.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pennon
GRIEGQ,OAViD PLUMBER] i -
UNDERGF20U $394•00 $182.38 $171.03 $26.23 $0.00 $0.00 $0.00
7 0 0.00 0.00 1.50 i 0.00 1.00 0.00 0.00 2.50 $63.85 $1,610.41 3478
ND UTILITY Admin I Trauel& Total
PIPEFITTER _ $1.323.88 $2,403.40 Training Fringes Dues Sub Savings Other Oeducl.
D 0,00 0.00 0.00 0,00 0.00 0-00 0,00 0.00 $0-00 $10.60 S0.00 $0.00 $0.00 $0.00 $19-35 $792.99
f _____ - I...
Other Deducton Nat,;:Training fee
- -- THIS ALL Federal FICA& State SDI Vac-aticn Health&. pension
j S 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16-00 $48.50 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
mSASLA MORGAN IER!
' PLUMB
ROU 3304.00 5t63.81 5132.64 522.11 $0.00 50.00 $0.00
0 O 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $63.95 • $1,397.97 3482
NO UTILITY Admin I Travel& Total
i PIPEFITTER - 3839.85 $2,027.13 Training Fringes Due3 Sub !Savings Other Deduct_
I ❑ 0.00 0-00 0.00 0.00 0-00 0.00 0.00 0.00 $0-00 $$_$0 $0.00 $0.00 $0.00 S0_00 $10.40 $629.16
I
- -- . -
Other Deducton Notes;Trainl g fee
I THIS ALL Federal FICA S State Vacation Health& 1
I S 0.00 0.00 B-00 0.00 B.00 8.00 0.00 24.00 548.50 PROJECT •PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension
STANFILL. I PLUMBERI
CHRISTOPHER ' UNDERGRCU $434.00 $182.38 $171.03 $26.22 S0.00 SO-00 $0.00
0 NO UTILITY 0 0.00 0.00 1.50 0.00 1.00 0.00 0.00 2.50 $63.95 $1,57G.42 3876
PIPEFITTER $1,323.88 52,403.40 Training Admin 1 Dues Travel& Savings Other Total
Fringes Sub €}edutf_
' D 0.60 0.00 0.00 i7.00 {I-06. 0.00 0.00 0.00 $0-00
JE $10-b) sr.. 50.00 50.00 50.00 519.35 $832.98
- -
Other Deducthn Notes:Training fee
S STRAIGHT TIME `OTHER-Any arbor 5educIion.contributions andlor payrrienls whelrier or rot included or required by prardriaig wage de:errrunalions merit be se.paratetr 1sted- CERTIFICAT}0Rl MUST tie completed
0=OVERTIME Use extra sheel(sy if necessary- SeerasrrusEgde
Form A 1-731(New 2.801
D=DOUBLETIME {
SOI=STATE DISABILITY INSURANCE
ids, California
Industrial
Rent oT 2022 Sowers&Bijou 2l3 Waterline Replacement Project i 20.34.8094 acid 2[1.34.82&7
liedusirialRetations PUBLIC WORKS PAYROLL REPORTING FORM
1') (2) f (3) (4)DAY (5) (6)- (7y (8) - Page
'
S M / T WIT PTs _
NAME,ADDRESS ng • WORK ��
AND SOQfAL a o , Date
SECURITY NUMBER z= cuss- 1 TOTAL RATEHOURLY GROSS AMOUNT
OF EMPLOYEE 3 I IFICATEC1td 5I01 51021 5143{5104 5f0 5Io6 IS'° . F CU S OF PAY EARNED
DEDUCTIONS.CONTRIBUTIONS AND PAYMENTS WFPAC
CR S CHECK NO.
i - _ Hours Worked Each Mr/
WEEK
If , THIS ALL Federal FICA$ State Vacation He 11h& _
S 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $43.50 PROJECT PROJECTS Tax Medicare Tax SDf Pension
J Holiday Welfare
�; ` PLUMBEF7/ I
1
1 UNDERGE4DU 0 0.00 0.00 0.00 0.00 0.04 0.00 0.00 0.00 $63.95 $298.a0 $145.34 $118.77+
UTlLIT( $2b• $0.00 �OAO $0.00
PIPEFITIER NDAdrrdn! Travel- •S1,a16•94 3882
$776.09 $1,915.75 Training Fringes Dues Sub Savings Other Total
t
Deduct
D 0.00• 0.00 0,00 0.00 0.00 0.00 0.00 0-00 $0.00
56.49 $0.00 $9.09 $0.00 50.00 $15.80 $598.81.
Other Deduc oI Noss:Training fee
S=STRAIGHT TIt+1E P-IER-Any ofhur ueducl ans,GorNritwr onS anrflor
Faun A-1-131 New 2-00} ❑a DOUR E�TIME peNne��rs ielhe a
Uso extra sheaug}If neef r galrea by prevailiriq wagedelermEnalrons meal be separately€slap. CEFt7lF1CA710,4NUST ae camplelad
SDI=STATE 0ISA13Lire INSURANCE (Sao .arse sde}
Department
rim 2022 Bowers&Bijou 213 Waterline Replacement Project/20.30.8094 and 20_30.8281
l7epartment of ! P j
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3of3
STATE OF OALIFORNiA
STATEMENT OF COMPLIANCE
CONTRACTOR/SUBCONTRACTOR CONTRACT NUMBER
Vinciguerra Construction,Inc. 20.30.81a94 and 20.30.8281
FIRST DAY AND DATE OF PAY PERIOD =!_AST DAY AND DATE OF PAY PERIOD
511 f2022 51712022
I do hereby certify under penalty of per,urr
(1) That I pay or supervise payment to employees of the above-referenced contractor on the above-referenced contract.All persons employed on said project for the above-referenced time period nave been
paid their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and hat no
deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions.
(2) That this employer has complied with the requirements of the California Labor Code Sections, 1771, 1811,and 1815 for all performed on this public works project,and that the classifications set`orth therein
for each trade rate conform with the work performed.
(3) That any payrolls otherwise under this control required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the
applicable wages rates:
(a) 71 Specified in the applicable wage determination incorporated into the contract;
(b) X Determined by the Director of Industrial Relations for the county or counties in which the work is performed;that the classification set forth therein for each laborer or med^anicoonforee
with the work he or she performed.
{4) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency,
(5) That fringes benefits as listed in the contract:
(a) 17 Have been or will be paid to the approved plan(s),funds(s),orprogram(sl for the beeefitof listed employee(s),except as noted below.
(b) x Have been paid directly to the listed employee(s),except as noted below.
(c) J See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
REMARKS: Except for Trainino Funds for ail Crafts paid directly to CAC.
NAME(PLEASE PRINT.) TITLE
Austin Vinciguerra President
SIGNATURE: e• DATE
5/2612022
on federally-funded projects,permissible deductions are defined in title 29,Code of Federal Regulations,part 3,issued by the Secretary of Labor under the Copeland Act,(40 U.S.C.276c).Also, thewilllul
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 3729 of title 31 of the United States Code).
ADA Notice For individuals with sensory disabilities,this document is available in alternate formats.Fof information call(916)654-6410 or TOD(916)654--3880 or write Records and Forms GEM 2503
Management, 1120 N S!reet,MS-89,Sacramento.CA 95814_