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Certified Payroll Reports 12 to 17 Bowers Bijou_Redacted N California I all' De Inds t Industrial R O1 2p022 Bowers&B,j6u 213 W leriine Rep acerneni Project!20.30.Sfl94 and 2a.3a.8281 Industral Relations PUBLIC /+ WORKS PAYROLL rv��yT� � �j r Lr 4� i.r Page_Of q I NAME OF CONTRACTOR:Vinciguerra Construction,Inc. CONTRACTOR'S LICENSE NO.:358838 I OR SUBCONTRACTOR: ADDRESS:P. Brix 157,Sutter Creek,CA 956B5 SPEC/ALTY LICENSE NO.: PAYROLL NO. WEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20.36.Sp9d and 20.30.8281 i 12 719 O22 WORKERS'COMP: PROJECT AND LOCATION:2022 Bowers&Bijou 2/3 Waterline Replacement Project,ELD �� FOR {1) 42} I (3) {4)DAY (5) (8) (7) _ c8f (s1 7.7 M I T I W I T 1 F I S NAME,ADDRESS gg j AND S n j WORK 1'RATL NET SECURITY BER Dg CLASS Date1 r TOTAL PRATE GROSS AMOUNT WAGES CHECK $_`' IFICRTfpN [ 7103 7104 7/05 71 1 71p7 7108 71p$ OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID OF EMPLOYEE fl "CURS �. FOR fr.. HOUrs Worksd Each Day I WEEK r� I f S 0.00 0.00 8.00 8.00 8.00 8.00 0.00 32.00 552.00 PROJECT PROJECTS F Taxal At d came STax SDI Vacation Health$ COWAN,THOMAS N6Fday Welfare Pension PLUMBER/ 0 uNl3ERGRCU 5-48.00 5185.85 5177.00 528.86 50-00 $0.00 50.00 I ND UTILITY O 0.00 0_90 2.00 2.00 2.00 7,.OD 0.00 8.00 $69.20 PfPEFITTER _ -$1.803.69 1001 j , $2.217.60 52,459.80 Training Frirel es Dues Travel Savings Other Total j Sub Darterck. j 0 0 00 0.00 0 00 0 00 0.00 0.00 0.00 0.001 50.00 - - r Si6.00 $0.00 $0.001 $0.00 30A0 517.40. 5856.11 f J I I - Oilier Deduction Notes:Training fee I S 0,00 0 00 8.00 8.00 8.00 8.00 0.00 32.00 $48.50 PROJECT PROJECTS FederalTHIS ALL Tax Medicare FICA& State Vacation Heath e I - SDI Holiday Welfare Pens,on CMG.CHR1.S i PLUMBER/ 0 tJfVOERGRDU $384.00 5179.11 S166.65 $25.75 $0.00 S0.00 $0.09 I ND UTILITY O 4.00 9.00 2.00 2,04 2.001.50 0.00 7.50 $53-95 - PIPERTTER , Adminr Travel& $1.585.79 1002 i $2.031.63 $2,359.10 Training Fringes Dees Sub Sa.irgs I C/hor Deduct. Total j I I 101 0.00 000 000 Q.Opf000 o.00 4.U00.0050.00 $15.$0 56.00 50.04 50.001 x4-00 $17001 5771 I 1 I Ogler Deduction Notes:Training fee THIS ALL Federal FICA 4 Slate Vacation Health& E S 0.00 0.00 0-00 8.00 8.00 8.00 0.00 24.00 $90.64 PROJECT PROJECTS Tax Medicate Tax SDI Pension DAVIDSON.SOCNE I Holiday Welfare �perdtlfLg I J Engineer $0.00 $236.87 50.00 $34.06 $0.00 50.00 $0.00 5119.6 0 {Heavy& 0 0.00 0.00 0.0u 2.90 2-00 1.00 0.00 5.00 - ,Highway 0 52,$2539 See I Gnaw 3 Area T ' S2.773.36 $3-132.16 Training Ad min J Dues Travel& Total Notes Fringes SSub Savings OtherII _ Deduct. I o 0.nn 0.00 0 00 0.00 00a 0.60 0_00 0.00 S0.00 - $32.48 50.00 80.00 50,00 50.00 535.84 5306.77 Notes:P check'aUmtzers:1003:1025:_ t r Other Deduction Notes:Training fee S=STRAIGHT TIME OTHER-Any other dedutL Jr s,contributions and or paymeai whe4i r d not slthided Ca It quire h Form A-1-131(New r-80} 0=OVERTIME Use e%Ir3 st�eat{s}if ram'. Y arevadng wage delerrrsna s rnusl be xgpara[eTy listed. CERTIF IEATtm1V MUST be c0myyfEied O=DOUBLETME [See iseeree side} SDI=STATE DISA8ELRy INSURANCE i diN California Department of 2022 Bowers Si Bijou 213 Waterline Replacement Project;20.3-0.8094 and 20.30.€5281 Industrial Relations d Q PAYROLL V d t11 I REPORT A PUBLIC WORKS r A 1 IWLL REPORT iG FORM Page 2 of$ {iI (2) i (3) ! (4)DAY (5) (6) (7) ($) (9) SIMI T I I T 1 1- I S NAME,ADDRESS z z d AND SOCIAL ogi? I WORK Date HOUR_ NET SECURITY NUl1lBER $r CLASS- TOTAL Y>zATE GROSS AMOUNT WAGES CHECK OF EMPLOYEE 3w I IFICATION 7iO3-I 7104 1 7I05 i 7/05 17l07 17/08 17F09 "FRS OF PAY EARNED DEDUCTIONS,CONTRFBE1TIOhlS AND PAYMENTS PAID NO y�I Hours Worked Each Day WEEK I THIS ALL Federal [FICA& State Vacation!Health 8 I �.3 000 0.00 0.001 0.00 6.00 6.00 0.00 12.00 $48.50 PROJECT PROJECTS Tax Medicare; Tax SDI Holiday Welfare Pen'son DEA ALUMBERI J 0 I UNDERGROU 5102.00 5132.55 5101.86 $19.08 $0.00 50.00 50.00 0I ND UTILITY 0.000 0.00 0.00 2.00 2.00 0.00 400 s63.95 PIPEFffTER _ _ $837.80 51,741.43 Traini Admin I Travel& Total $1.378.50 1004 Fringes Cuss Sub Savings other _. Deduct I . 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 50.04 56-40 $0.00 50.00 50.00 $0.00 57-40 $362.e3 Other Deduction Notes:TierniscLree i THIS ALL Federal FICA A State Vacation 1 HSalth& I 5I 0-00 0.00 £s,0u, 8.00 8.00 8.00 0.00 32.00I 548.50 PROjECT PROJECTS Tax Medicare Tax Sol Pgns•nn GRIEGO,DAVIC _ Holiday Welfare i 7- PLUMBER! 5366.00 $1i3.65 $159.36 $24.97 50.4t] 50.00 50.00 0 (i1NDEF2GRDU 0 0.00 0.00 2.00 2.00 2.00 1.50 0.00 7.50 563.95 j ND UTILITY PIPEFITTER Admin Travel$ $1.54fi.05 100s 52,031.fi3 52,287.43 Training Fringes Dues Sub Savings Other T tat Deduct. D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.80 $0.00 $4.00 $0.00 50.00 51740 $7d1.38 r _ [ Other Deduction Notes:Training fee 1 1 i I I T`15 ALL I Federal FICA 8 State Iocarci n :Lead..- S 0.04 0.00 8,00 800 8.00; 000 0.00 24.00 $52.00 PROJECT PROJECTSf Tax Medicare Tax Holiday WelfarePensign jjjjTOjj1 1DR PLUMBER! • - 111VDERGRDU S47.00 $131.58 $89,45 518,92 50.00 50.00 50.01 0 C 0.00 0.00 2.00 2.00 1.50 0.00 0.00 5.54 $fi920 ND UTILITY PIPEFITTER 51,433.05 7005 I - $1,$28.60 51,732.40 TrainingAdfn'n f Travel& Total Fringes t]$0- Sub o SavirTgs 51 er 5299.Deduct. D 0.00 0.00 0-00 0.00 D.00 0.00 0.00 0.00 50.00 "� j 511.80 50.00 $0-00 $0.00 50.00 512.40 5293.35 i ___I Diller Deduction Notes:Training tee THIS ALL Federal FICA& State `� F a 0.08 0.0o ts•co u.00 8.00 7.uu 0.00 31.00 Sa6.50 PROJECT PROJECTS Tax Medicare Tax sot vacation Welfareelfh e PensIOF MOSQ EDA. I Hakday fl1 AR PLUMBER 0 I UNDERGROU 3255.00 5150.521 5125.71 52115 $0.00 50.00 $0-00 I ND UTILITY 0 0.00 9.00 2.t10 2.t30 2.0p O.iJD 0.00 8.04 563.96 _ PEPEF ITTER Admin 1 Travel& $1,401.85 1007 51,887.20 $1,993.13 Training Dues Sawn Total I FrrrJes Sob Savings Other Deduct. 0 0.00 0.00 0.00 0.00 0.09 0.00 OM 0.00 50.00 - -a_,_,_ 514.80 50.00 50.00 50.00 50-00 515.40 5568.26 Other Deduction Notes:Traini +fee S=STRAIGHT TIME 'OTHER--Any other deductions,coeInbultons ar4Io Fern A-1-131 O=DOURLEAE payments gig�} �S]i1 races°r mired by prava lwsg wage Bete minapons n F be teperatey Isted. CERTIFtGAiION d fiJST be cgrnple[sd Mew t�0} O=DOUBLET NE 501=STATE DISASiLUTY INSURANCE (See reverse side) California Deparinieni of 2022 Bowers&Bijou 2/3 Waterline Replacement Project/20.30.8094 and 24,30,8281 industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM (1) (2) (3) (4) (5) (6) 7 Page9) of DAY � } {$) NAME,ADOREa5 I SIMITIWITIFIS t9f AcE,ASOCIALDORE o° C WORKR Date NET SECURITY NUfaBER Q=� l TOTAL y.,E GROSS AMOUNT WAGES CHECK OF EMPLOYEE I IFiCATIQN 7/03 17/04 7.05 17f05 7/07 i 7/08 17109, Rs pFPAY EARNED D'cO ICriaNS,CONTRIBUTIONS AND PAYMENTS PAID l FOR N� Hours Worked Each ay WEEK THIS I S 0.00I 0-00 8.00 8.00 8.00 8.00 0.00 32.00 $48.50 PROJECT I PROJECTS ALL Tax Federal FICA State SO! Vacation Welfare e ONETO I Holiday Welfare Pension 1-- PLUMBER 1 $345.00 S179.11 $163,92 325.76 $0.00 $0.00 $0.00 0 I UNOERGROU 0 0.00 0.00 2.00 3.00 2.00 1.00 0.00 7.00 $63.95 - NO UTILITY PIPEFITTER Adrnin/ Travel& $1,b27.51 1008 I i- _ $1,999.65 $2,359.10 Training Fringes Dues Sub Sa"'"gG Other Deduct D 0.00 0.00 0.00 0.00 0.00, 0.00 0.00 0.00 $0.00 $15.60 $0.00 30.00, $0.00 $0.00 517.80 $731.59 Other Deduction Notes:Twining fed l THIS ALL Federal FICA& State SDI Vacation Heath& S 0.00 0-00 8.00 8.001 8.00 8.00 0.00 32.00 $52.00 PROJECT PROJECTS, Tax Medicare Tax , Holiday Welfare P-si+t ONETO, I CH t ❑ PLUMBER - _ 0 UNDERGF3pl1 $332.00 $205.93 $197.05 $29.61 $0.00 $0.00 $0.00 ND UTILITY O 0.00 0.00 2.00 2.00 2.00 2.00 0.00 8.00 $69.20 PIPEFITTEft Adn ng Travel&' Total 51,791.6$ 1009 - 52217.60 $2.710.60 Training Ones Savings Other 9a Sub Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 I - $36.00 S0.00 10-00 $0,00 $0.00 $154.33 $918.92 Other Deduction Notes:Train#ng Fee art¢CalSavers contribution f • f 1 THIS 1 ALL ,Feft:al FICA C. Sate �rta^ a ;. r Health I S 0.00 0.00 8.00 8.00 0.50 2.50 0.00 19.00 $48.50 PROJECT PROJECTS Tax Medicare) Tax SDI Holiday Welfare Pension PASTEN VELASQUFZ, PLUMBER f - ELISIO 0 UNOERGROU $279.00 $170.20 $14929 S24.48 $0.00 $0.00 $0.00 ND UTILITY O 000 0.00 2,00 2.00 2.00 0.00 0.00 6.00 S63.95 PIPEFiTTER $1,601-95 1010 51.305.2Q $2 242.22 Training r Dues Travel& Sarin Other Total Fringes Sub Savings Deduct_ ' D 0.00 0.00 0_00 0.00 0.00 0.00 0.00 01)0 $0.00 510.00 $0.00 $0.00 $0.00 $0.00 $17_30 $640.27 Other Deduction Notes:�r0$1g fee.` TH S s ❑.ap O.op e3.w g,ou o.so 2.5Q 0.00 19.4b �48.50 PROJECT PROJECTS Federal FICA& State SDi Vacation Health& SABfA.WIDRGAN ` I LI Tax Medcare lax Holiday Welfare pennon ❑L UMBER/ 0 uhtDE12GROu $394.00 $182.35 $171.00 $2622 50.00 50.00 50.00 NO UTILITY 0 0.00 0.09 2.00 2.00 2.00 1.00 0.00 7.00 $63.95 _ PIPEFITTER _ $1,369.15 $2,402.10 Training Adrnin I?ues Travel& Savings Other Total - $1,610.22 1013 IFringess sub n9Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 i $10.40 50-00 $0.00 S0.00 50.00 $18.30 1791.88 Other Deduction Notes:Training fee S=STRAJGHT TIME 'OTHER-,any other deductions,contributions arwrar payments whether n not included or Fern A-1-13/Neel:-8a O'DOURLETErequired by prevaitng wage determrnedms muse separately haled. CERTIFiCAT1ON MUST be completed0=OVER ETtr,FE Use mdra sheettsy if necessary. (See reverse side) SDI=STATE DISABILITY INSURANCE a I Califamla DepartmenE ai 2022 Bowers S Bijou 2(3 Waterline Replacement Project 120-30_8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REP ORT:".G FORM rsage4o (t) (2} I (3) {4}i]AY {5} (6} (7) 3 T W T r F S (8) f Q (9) NAME,ADDRESS x,i I AND SOClE4 o a WORK Date NET SECURITY NUNBER d= CLASS- _ TOTAL Y �e GROSS AMOUNT WAGES CHECK_ � ! IFICATIOht 7103 7II HOURS EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID OF EMPLOYEE 3 w I f04 7l05 7lt36 7147 1710817109 7109 OF PAY FOR EE NO. Hours Worked Each Day WEEK THIS ALL Federal FICA& r State SDI Vacation Health& S 0.00 0 DO 8.00 $.00 8.00I 8.00r 0.0(1 32.00 $52.00 PROJECT PROJECTS Fax Medicare Tax Pension LTANLL tiolidap Welfare PLUMBER - _, . 0 UNOERGROU $448-00 $186.64 $177.00 $26.66 $0.00 $0.Q11 $0.00 ND UTILITY 0 0.00: 0.00 2.00 2.00 2.00 1.50 0.G0 7.513 $69.20• _ PIPEFITTER Adminf Travel • S1,480.71 ` 1014 _ $2.183.00 $2,459.80 Training Fringes Dues SEtb Savings Other Total __ Deduct 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0-00 l $15.80 $4,00 $0.00 $0.00 $0.00 $140.39 $979.09 Other Deduction Notes: THIS ALL Federal FICA& State Vaal ; h& . .00 8.00 0.00 32.00 $62.00 PROJECT PROJECTS Tax Medicare Tax 501 P 5 0.00 0.00 800 8.00 8 PRO ension TAYLOR. _ Ftoeday Welfare KRISTOPHER PLUMBER! R - - - - 1 11Nt7ERGROU $311.00 $192.10 $181_30: $27.62 $0.00 $0.00 $0.00 NO 1JTIL1TY 0 0.00 0.00 2.00 2.00 2.00 1.50 0.00 7.50 $B920 PIPEFITTEl2 Adrrsinl Travel $1,799_1$ 10t5 _ $2,183.00 $2,529.00 Training FnngeS Dues sub Savings Older Total Deduct. 0 0.00 0.00 0.00 t 0.00 0.00 0.00 0.00 0.00 $0.00 $15.80 $0.00 50.00 W.00 $0.00 $17.80 S729.82 --- I. Other Deduction Notes:Traini0a fee l I t I 1 I ! rHIS 1 ALL J 5 0.00 0.00 8.70 6.00 5,00 2.00 0.00 23.OQ $85.64 PROJECT i PROJECTS F Terre. CA& State 1 SDI Vacatlal Health t.e 1 I VINCiGUERRA, Medicare Tax Holiday Welfare pensoe AUSTIN ° aling _ Y_ Engineer - $645.OE1 $31304 33aG,28 $d5.Q2 $G.OQ SO-OQ S>7.G0 2 (H9avy A, 0 0.00 0.00 2.00 2.00 2.00 1.00 0.00 7.00 S112.1 Highway wdtk)! 0 - $2,74$_55 1016 Group 3 Area 1 _ $2,754.42 $4,1d1.73 Tlrariling Arimnt Dues Travel& Sav Total Fringes Sub • s Other Dedl�ct. • D 0.00 9.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 1 $33•80 50-00 '$0.00 $0.00 $0.00 $49.84 57,393.1 8 Other 0eductiar•,Notes:Training far 1 a o.ou D.G4 6.00 a.00 a_aa S.t7or OAK) 30.00 385.64 PROJECT PRO EGTS Federal ;Medicare lax Sidle Sr31 natation'Health a penyran VINCIGI}EfzRA IHoliday Welfare CASEY Operating ! Engineer $384.00 $236.43 $232.38 S33.99 $0-00 $0.00 $0.00 4 (Heavy& 0 0.00 0.00 0.00 2.00 2.00 1.00 ate 5.00. S112.1 IHighway work)1 0 I Group 3 Area 1 - $3,729.70 E3,T29.70 Training FriAdmin/ Dues Travel& Savings Other Total - $2.047.21 1017 n9 SubDeduct. D 0110 0.00 0.00 0.00 0.00 0,00 0.00 0.00 $0.00 - I $39_0 $0.00 $0_00 $0.00 $0.00. Si95.69 $1.082.4 • f 9 Other Deduction Notes: S=STRAJGKT TIME 'OTHER-Any other deduction.nontrambo is and/or O E OVE8TIME AQ]'+r1 's whether yr not included or required by prevailing wage delrnynancns roust be separately life¢. CERTIFICATION MUST'be ❑=DOUt3LETPiaE Use extra sheel(s}if necessary. (See reverse side) ed Farm A-1-131(flew;-80 SO/=STATE nISA6rlTY INSURANCE a i Cal a tria tme l partmnt ofRelations 2022 Bowers 8 Bijou 2/3 Waterline Replacement Project/20.30.8094 and 26.30.8281 Indu❑es 0) a) PUBLIC WORKS PAYROLL REP RTEIi G FORM Page�ofSz{3) (4)DAY (5) ; (6) ► (7) (8) 1 simiTwrTIFIS NAME.ADDRESS =31 J AND SOCIAL o ig ti WORK Date HbURL NET SECURITY NUMBER o_ GROSS AMOUNT WAGES GGK TOTAL OF EMPLOYEE x'x r ICAT1Oiv 7 D3 7104 710$ 7106 7lQ7 710$ 7109 �U OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID FOR NO. Hours.Worked Each day r s WEEK THIS ALL Federal FICA& State I Sbl Vacation Health S (.90 0.00 B.QO 8_00I 8.00 8.00 0.00 32.00 590.84 PROJECT PROJECTS Tax Medicare Tax I Pension I Flo5day Welfare Operating YOUNG.JIM I Engineer $715.00 $329.02 5384.39 S47.30 $0.00 $0.00 $0.00 1 'Highway{Heavy& 0 0.00 0.00 2.00 2.00 2.00 2.00 0.00 6.00 5119.(i work).1 0 - 52,627-66 162E l Group3 Area 1 53,857,28 34,350.76 Training Admin! Du" Traver& Total' Fnrrges Sub Savigs Other Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54.00 I $44.80 $0.00 $0.00 30.00 $0.00 S288.79 31,722.5 a Other Deduction Notes:Trafrenpj9e and CaiSavers contribution S-STRAIGHT TIME 'OTHER-Any other deductions,ccnirixrtions anvo FormA-.1_131(New 2-8U} Q=STEAK T payments whetteer or not inducted or required by prevaiiag wage determinatlans rnust be separxotty lxied. CERTIFICATION 0=DOIJBLETIM� Use extra s1w ttsy it necessary. h+lre be completed 56t=STATE DISA63LITYINSUJRANCE (See reverse siCe) I idpil California Department of 2022 Bowers&Bijou 2/3 Waterline Replacement Project/20.30.8094 and 20,30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FOR?'� STATE OF CALIFORNIA Paget of STATEMENT OF COMPLIANCE CONTRACTOR I SUBCONTRACTOR CONTRACT NUMBER VINCIGUERRA CONSTRUCTION, INC. FIRST DAY AND DATE OF PAY PERIOD 20.30.81194 and 28.3t1.828? LAST DAY AND DATE OF PAY PERIOD 71312022 I 7/9(2022 do hereby redly under penally of perjury: _I (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 have been paid their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to er on behalf of said contractor from the full weekly wages earned by 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. (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 forth therein for each trade rate conform with the work performed. (3) That any payrolls Otherwise under this control required to lee submitted for the above period are correct and cornplete;that the wage rates for laborers or mechanics contained therein are not less that the applicable wages rates: I (a) 0 Specified in the applicable wage determination incorporated into the contract; (b) 0 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 mechanic conform 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 Meg es benefits as listed in the contract: I (a) ElHave been or will be paid to the approved plan(s).funds(s),or program{s}for the benefit of listed employee(s),except as noted below. (b) X] Have been paid directly to the listed employees},except as noted below. (c, ! See.exceptions noted belev.' EXCEPTION CRAFT I. i EXPLANATION REMARKS:Except for Training Funds for all Crafts paid directly to CAC. NAME(PLEASE PRINT.) Austin Vinciguerra TITLE President SIGNATURE: I.°Ft)F4--------- } aATC i8/2/2022 On federally nded 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,the willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution(See section 1001 of tide 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.For information call(916)654-6410 or TOO(916)654-3880 or write Records and Forms CEM2503 Management, 1120 N Street,MS-89.Sacramento,CA 95814. EN Ce Departmentdustriat111 2U22 Bowers 8 Bijou 2J3 Waterline Replacement Project 120.3D.8D94 and 20.34.8281 Industrial RelationsPUBLIC WORKS PAYROLL REPQRTiNG FORM I NAME OF CONTRACTOR:Yrrciguerra Construction,Inc. Page 1 Of 6 I OR SUBCONTRACTOR; CONTRACTOR'S LICENSI NO,:356638 ADDRESS:F.Q.Box 157,Sutter Creek,CA,35G85I SPECIALTY LICENSE NO.: { 'PAYROLL NO. FOR WEEK ENDING: JSELF_INSURED CERT:I 13 711tif2022 WORKERS'COMP PROJECT OR CONTRACT NO.:20.30.8094 and 20.30.8281 : PROJECT AND LOCATION:2022 Bowers&Bijou 2!3 Waterline Replacement Project,ELI] (7) (2) r {3] (4)DAY (5) (6) (7) 18) S j M l T I W [ T F 1 S • �81 {9) NAME,ADDRESS w o 8. 1 WORT{ AND SOCIAL o6 I HDURL NET SECURITY N J ER F CLASS- r Date TOTAL y RAT GROSS AMOUNT WAGES CHECK EMPLOYEE i�` I IFiCATiON 7I70'7ft1 7l13�7l14 7l15 1711$ r1013ftS OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID 1 FOR Hours Worked Eash Day WEEK I THIS ALL Federal FICA$ Stets Vacation Health& $ 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDl holiday WelfarePension 111111 I PLUMBER 0 I UNDERGROU' - - $0.00 348.67 37.27 �r7.03 30.00� $R_00 $0.OQ I NO UTILITY 0 0.00 2.00 0.00 0.00 0.00 0.00 0.00 2.00 $63.95 PIPEFITTER - Admin! 7ranei&- $5-75.83 1028 5515.9[} $fi43.80 Trainng Dues Total I I I Fnn9 Sub s Other uct 0 0.00 0.00 0.00 0.00 0.00 0.00 0 00 0.04 $4.nn $4.00 3090 $0.00 $0.00 $0.00 34.80 $67.97 I[ J -.� _i_._ Other Deduction Notes:Training fee I S 0.00, 8.00 8.00 8.00 8.00 8.00 0-00 40.t70 $52.00 PRQJIECT PRO lECTS F Taxes Medicare Tax $e DI Vacation Health B 1 COWAN,TFtOMtiS I PL>A446ER! - F[ofiday Welfare Pension 0 1 UNDERGROU 3596.00 $234.21 $240.34 $33.68 $0.00' $0-00 $0.00 1 NO UTILITYO 0.00 2-00 2•00 2.00 2.00 2.00 0.00 10.00 389.20 i PIPEF11-11=i - FldmineS •Travel& nys $1.957.37 1027 .772.00 $3,{383.40 Training Fri Saai Total 1 r►9 Scb DeduUl- D 0.001 0.001 0.001 0.001 0.00 0.001 0.00 0-00 $0,00 $20.00 30.00 $0.00 50.001 $0_001 $21.80 $1128.0j I3 I Other Deduction Notes: ining fee I S 0. 0 5.00 0.00 8.00 8.00 0.00 0.00 2 S.t30 $48.50 PROJECT PROJECTS THIS ALL FeTdaxal FICA Medicare& Tax Stale Vacation Flealh SDIHoiday Welfare Pension LRAlGRIS I PLUMBER r • 0 I UNDUTFLIT ] 0 0.00 2.00 0.00 2.00 2.00 0.00 0.00 6.00 563.95 $234.00- $129.63 $100A9 $18_64. $0.00 $0.00 $0.00 I ND UTILITY PIPEFITTER _ I _ 51,547.70 $1,707.58 Training dmin pis T + & 9 1 her Taial - $t.211.82 i028 I _____±_______±__. FringesSuq Sevin s Deduct_ .0(} OM 0.00 O.t n 0 onf 0_00 a_n4 o.ex3i s4.00{ Si2.00 5�.06 $0.00 $0.00 $0.00 $13.tlp� $495.76 I JI i Other Deduction Notes:irj2In{m fee S=STR.AICTIMEl sr 7e arrsea-Arty other da�,cmr o- ,rra,g anawr Form 4-4_131(Mew 2-80) C.D0 OVERT�T E riayrnerns whether or not inch/dad drrequrced by prs„aivua wage dcyernni umust� _ y ara[ely faxed. C tTIFiG4TIflN MUST be r�mplt;red O=OVERTIM S01=STATE DISABILITY INSURANCE Use extra sheeI{e)it necessary. {See reverse side ail California Department of Industrial Relations PUBLIC WORKS PAYROLL REP ORT":2022 Bowers&8ijolu 2(3 Waterline Replacement Project 12fl.34.8694 and 20.30-8281 .G FORM (1) (3) (4)DAY [$) ffi i Page ai 4 HET (7} (9) NAME.ADDRESS °z I S I M I T L W E T I F [ S f$) AND SOCIA_ 8.9 7 f WORT[ NET SECURITY NUABE32 = 1- EARNED Date _ TOF al y RATE GROSS AMOUNT WAGES CHECK OF EMPLOYE kw f !FICA-HON • 7r10 L 7r11 1 7112 1 7/13 1 7i14 1 7115 l 7716 HOUR- OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAIL] f FORNO. Hours Worked Each Day WEEK I $ 0.00 0_pD 5.50� 8.4D $.00 fi_00 0_DO 27.50 THIS if ALL Federal PROJECTS Tax I Medicare Tax FICA& State 1Vacalion Health& �- I $a8.50 PROJECT I SDI Holiday Welfare r Pension DEARAIUUN,NC( PLUMBER 1 �_ 1 0 f UNt7ERGRDIJ $331.00 $225.19 $225.54 $32.38 $0.00 $0.30 $0.00 I ND UTtLlTY 0 0.00+ 0.00 2.00 2.00 2.00 0.00 0.00 6.00 S63.95 PIP1 FITS ER Adrnin f Travel& �"${•129.49 1 Q29 Total $1,717.45 $2,960.60 Training Fringes Sub Dues Savings Other Deduct 0.00 0.00 0.00 0.00 0.30 0.00 3.00 0,00 50.00 I -. ---t-- $13.40 $0.00 $0.00 $0.00 $0.00 $17.00 $831.11 Otter Deduction Notes:I of 12 fs THIS ALL Federa! FICA , State Vacation Health& I S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $48.50 PROJECT PROJECTS Tax Medicare Tax Pe GREGG,I DAME _ SDI Hoiitlay Welfare ^s nn PLUMBER1 "- �- t r _ 0 #UNDERGROU $527.00 $224_68 5227_98 $32.35 $3.00 $0.30, $0.00 f ND UTlL1TY 0 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10.00 $53.95 PiPE1=lFTER �� .. 52,579.SD 52,963.20 Training Admrn1 sues Travel& Total $1.928.49 I030 ff Frnges Sus Savings Other ()tsduci- f D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Q.00 $0.00 f $20.00 Mao S0.00 50.00 $0.00 $22.40 $1'U34.7 r 1 1 Other Deduction Notes Training fee i I t I THIS ALL I Federal t FICA& State • {:a�:,:iv^i eaN.r& I I LOPEZ f S J_DOI 7-50 8.00 $-DO 5.50 8.00 0.00 32.00 $52-q0 PROJECT PROJECTS lax Medicare Tax SDI Pension ALEJAN OF2RES. f !fHoliday 1 Wefare ALEJANDR4 PLUMBER! D f L7NDERGROiJ C 0.00 0.00 0.00 2.00 0.00 0.50 0.00J 2.50 569.20 51 .00 $142.11 $1&3.53 $20.43 $0.00i SODS a0.u0 f NO UTILITY PIYEFITTER r - $1,514-53 1031 f $1,837.00 $1.871.60 Training Fringes Dues Travel& Savings Other Total f _� Fringes Sub Deduct._ ❑ 0.00 0.00 0.00 0,00 0.00 0.00 i3-04 0.00 S4.Oa $13.80 $0.00 $0.00 $0.00 $0.00 $14.00 5357.07 I Other Deduction Notes:Trainir,g fee I 5 a.00 8.00 5.00 8.00 8.00 8.00 0.00 40.00 348,50 PROJECT PROJECTS Federal Medicare,. x Vacation e SDI Holiday Welfaelfa e MGSQUEDA, I re Pension ARTURO PLUMBER! - 0 f UNDE72GRGU $405.00 S198.23 5189.50 520,50 50-00 50.00 $0.00 I ND UTILITY 0 0-00 0.50 2.00 2.00 2.00 2.00 0.00^ 8.50' $63.95 PIPEFITTER �� Acrnin! ' Travel& 51,770.05 1032 $2.483.58 52,611.46 Training Dues Sevin Total f f Frir. es Sub 9s Other Deduce. D 0.00 3_00 0.00 0-00 0.00 0_00 0.00 0.00 Sao° �- I 519.4t3 50-00 $0.00 50.00 54.00 52020 3841.43 Other Deduction Notes;I n f O= S=8TR{'itGOVERTSN.'iTEons.ca TIt,IE 'OTHER- Oiler Reducti rrt n'tw!iens an6lcr payments whether or not included a required by reevairng erage determinations Ferro A-1-t3i I•vew�bt Use extra sheei(e if rweµry t be separately listed. CERTIFICATION.-1 Arse d Completed ❑ I=STATE DISABILITY (See reverse sides SDI=STATE❑ISAHILfTY IFrSEj{2,7NCF dill California Department of 2022 Bowers&I Bijou 2/3 Waterline Replacement Project f 20.30.8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM (1) (2) {3) r (4}DAY I (5} (6) ' IT) Page 3 0,- NAME,ADDRESS z z i S M T W I T l l I S .. AND SOCIa o o a WORK Date HDURL NET PAD SECURITY CIA. Eli a= . CLASS- _ TOTAL GROSS AMOUNT CHECK OF EMPLOYEE _ I IFICATIC]N 7r10 7111 17112 7I131 7114 1 71151 7J16 His OF�PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS WAGES FOR N0. WEE Hours WCrlced Each Day s I THIS ALL I S 0.00 8.00 8.001 8.00 8.00 B.00 0.00 40.00 $48.50 PROJECT PROJECTS Federal Medicare CA& Tax SDI Vacation Health& Pension DNETO,AAR01h I HoGd2y 41eKara F'LUMDERJ , 0 I UNDERGRDU $466_00 5217.68 $215.50 $31.30 $0.09 1 ND UTILITY 0 0.00 2.00 2.00 2.00 2.00 22_00 0.00 10.00 $63.95 $Q'b0 Sa' I PIPEFITTER Atlmin I Travel& 31,915.nil 1033 1 52,579.50 $2,857.28 Training Fnnges Dues Sayings Other Tela! 1 ge SupDeduct. D 0.90 0.00 0.00_ 0.00 0.00 0.00 0.00 0.00 $0.00 - $2o_oo 30.00 $O.CO $0.00 3D_OD S21.80 $952.28 I r Other Deduction Notes:Training fae + THIS ALL 1 Federal FICA& $fate Vacation Health 8 i 5 0.00 s.ou a.o� 8.00 7.so s.00 0.00 39.50 $52.00 PF OJECT PROJEC 18 lax 1Neoieare Tax sot LNETO. I Holiday Welfare Penslor+ CHRI$TOPHER11. PLUAAB£RJ r 0 I ND UTILITDU 0 0.00 2.00 2.00 2.00 n.CO 2.pp 0,00 8,00 Sfi9.20 $419.G0 $23&.18 $237.52 $33.97, 5Q.00 50_p0 $0.00 1 ND UTILITY _ 1 PIPEFITTER Admire J Travel& 52,605.27 1034 $2,607.60 $3,109.20 Training Fringes Dues 5vG Savings Other Tofa! I Deduct. D 0.00 0.00 am am Q.00 0.00 am n.06 $0.06 1 $19,00 $0.00 $0.00 $0.00 $0.00 3177.26 $1'103.9 3 Other Deduction Notes:�}nino fee and Cal$evers n ripytiort f TX1S I ALL I FederalFICA l Stale. ,I S 0.00 8.p0 8.D0 8.00 0.00 0-00 0,00 24.00 $4S5D PROJECT PROJECTS Tax Medicare SDI Iva ;ia� ea,".5& 1 Holiday Welfare Pension I VELA5QUEI, PLUMBER J - _ fELiSlt7 0 I UlVD1 RGROU $326.00 $t85.43 $163.ot 526.66 $0.00 $0.00` $0.00 I ND UTILITY O 0.00 2.00 2.00 2.00 0.00 0.00 0.00 6.00 $63.35 FIPEFITTFR $1,547.70 $2,442.80 Training Admire 1 Dues Travel& - S1,716,07 1035 1 Frnges guh savings�4 Other DedcTotaisl ct. D 0.00 0.00 0.00 6.60 0.00 0.00 l 0.00 0 00 $0.00 512.00 50.00 $0.00 30.00 $0.00 519.00 $728.73 1 l f I Other Deduction Notes:Treirin4_fe@ THIS I 1 s 0 00 6.00 6.00 6.00 0.00 a_00 0.00 32.00 $52.00 PROJECT PHo ECYS Federal meFdicare State sal Vacationday Welch e PEREZ,SERGID PLUMBER! - Holiday Welfare �4^ '°`� 4 I LNO UTFLROLf o 0.00 2.00 2.00 2.00 0.00 2.00 0.00 8.004$69.2Q 3551.00 $226.28 S227.01 $32.54 S0.00 $0.00 $0.00 1 ND UTILITY 1 PIPEFITFER _ $2,217.80 Admire! Travel 31.921.13 1036 52,973.5& Training Frirt as Dues Savings Other T°rat I 9 SubDeduct, 0 0.00 0.00 0.00 0.00 9.00 0.00 0.00 0.00 $0.00 I S 518.00 $0.06 $0.00 50.00 50.00 321.60 L$1.058_4 L I Sri_ -1_--__. Other Deduction Notes:Training lee S=S7W1ftaiT T THE 'pTNER- O OVERTIMEAra tithe deriuclion contributions and/or payments whetherSr not un (Lded Dr required hY Arse'a rag wage determinations e et be seraaratety listed. CEfi 7]FICgTfr MUST be oompl�ed For q-t_131(7 ) o=0VER7i TH is Sof=STATE DJSC41LuTY,rdSURZANC7 Use extra sheens]if necessary, (See reverse sides Hil , aepa i Indsria rilnent ofid 2022 BowersPO 8;Bijou F 2/3 Waterline Replacement Project il 20_30.8094 and 20.30.8281 Indutltal Relations PUBLIC WORKS PAYROLL RE RT„NG OR Page4a f t41 JJAY (5) (6) (7) ' (8) �&' I S hi T J 4t' I t ! ts� NAIuIE,ADD RJ55 ?a I AND SCOW ....0 f WORK pa.e 1-- NET SECUR1TYIVUNBER =_ CLASS- ,,,,,, HOl1Ftl GROSSY RATE -AMOUNT WAGES IFECRTION 7ft0 711i 7II2 7/93 7/14 7/t5 7f16 14Oi1Ra OF D!~I]IJGTIQh15,CONTRIBUTIONS AND PAYl1EtJT5 PAID CHECK OF EMPLQYEEwEARNED i ] FOR NO. i Hers Worked Each Day WEEK THIS ALLFICA& 1 i I 5 0.00 8.00 8.00 0_00 0.00 0.00 0.001 16.00 $48.50 PROJECT PROJECTS l Taxes! Medicare Stateax SDI P Vacation Health& "SABIA,MOFGAV I i-Joliday Welfare enSlon PLUMBER/ - 1 0 UNOERG1SDL1 $432.00 5194.55 S187.31 527.97 $0.00 $0.00 SO.00 I ND UTILITY 0 0.00 1.00 2.00 0.00 0.00 0_00 0.00 3.00 5Ji3.95 I 1 PIPEFITTER Admin/ Travel& �, - 31,701.35 1038 $967,8i $2.5fi2.98 Training Fringes Dues Sub Savings Other Total 1 Deduct. p 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 50.00 I ] $7.60 50.00 $0.00 50.00 $0.00 $19.80 5861.63 Other Deduction Notes:Training f-o 1 THIS ALL t ederal FICA 8� 1 S 0.00 8.00 8.00 8.001 +i.00 8.- O.00 40.0G 552-0u PROJECT PROJECTS`' Tax Medicare Taxe Sol Vacation Health e HeSbday WeifSre PeriS pn STANFJLL, i PLUMBER! _ CNRl�T4PlJ'R - $604_00 $236.84 $243.86 $34.06 $0.00 $0.00 $0.00 0 =IJNDETILITY 1 0 0 Eir3 2.00 2.00 2.00 2.00 2.00 0.00 10.00 $69.20 ND UTILITY PIPEFITTE>t Travel& $1$21 1039 1 �} - _ $2.772.00 53,118.00 Training Adml Dues Savings Other Total 1 n9 Sub Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 5z0.g0 £0.00 woo 50.b $Q.OU $177.00 $1.29fi_6 fir` � 6 Other Deduction Notes:Training Je en�C� Savers r arbi Inn I I I I 1 1 I S 0.00 a 0 0 8.00 8.00 8.00 0.00 0_00 32.00 $52.001 PROJECT PROJECTS THIS : ALL1 F Taxal Medicare Tax SDl FICA 4 Stale Va a�an 1 oz!t! g i ] TAYLOR, 1Hotdav 1Ne3!fere Pension KRISTCPHER PLUMBER f 1 UNDERGROLJ 3446.00 S23I.59 $231,38 $33.30 $0.00 $0.00 S0.00 . II ND UTILITY O2.00 2.00 0.00 0.00 8.00 5fi9.20 1 PIPEFITTER _ Rdmin i Travel& $2.124.95 1040 I $2,217,60 $3,048.80 Training Fringes Dues Savings Other Total 1 O.OQ 2-00 2.00Sub Deduct_D J}.Q0 0.00 0.00I 0.00 0.00 0.00 0.00 0.00 $0.00 $16.00 Su_00 $0.00 $6.00 $0.00 $21.60 $923.85 a • ; I Other Deductiert Notes:Trairiirlg:e§ TI-IfS ALL Federal FICA& State Sol Vacation Health& 5 Q.00 ❑_oa 8_e7p p-op a.oa Q.pp' O_GO 8.ptl $9u.8a PROJECT PROJECTSrax N1ediCa ra Tars VINGIGUEfRRA, rHoliday Welfare -'''Sign 4UST1N I Operating I Eng-ieer � $685.00 5325.73 5357.27 $46.83 $0.00 $0.00 2 (Heavy& 0 0.00 0.00 2.00 0.00 0.00 O 0.00 2 IOMh19hv+aY work)/ .06 $f12.1 $0.00 ❑ $2.843.i❑ 1041 1 Group 3 Area 1 _ _ $909.32 $4,305.53 Training Adntin/ DIes Travel& Total J Fringes Sub savings Other D 0.00 0.00 0.00 0.00 0.00 0_00 0.00 0-00 $0.00 Dedct. 1 s 511.20 80.00 30.00 30,00 $0_00 347.60i 31.462A 3 iOther°eduction Notes-.Training fee S=S7RAEGHT TIME 'OTHER-Arty other deductions,�Ir�buliores a Form A-I-13� 0=DOUEILETI ridlpn AaYT' t5 wfiether a not irxirJded w squired by prevailing none deFsrminatimig mum L•e s9paralely&steel_ CERTIFICATION MUST be completed Ilew:EO} {7=OVERTL TIb IE Use exlra shaet(5}if necesry. SDI=STATE DISAeJLrty INSURANCE (Sae reverse 5ide) icrilli,i California rnent of 2472 Bowers 813i;oca 2/3 Waterline Rel]Iacernenl Project 120.30.8d94 and 2{}.3C.$2$1 IndustrialDepart Relations PUBLIC WORKS PAYROLL REPORTING FORM(1) (2} (3) (4)DAY (5) {6) {7} {$] �3 of S M T W T F S I (9) E.A00R65 z z I I I L ]� _ AND SOMA! 6.1 Q WORK Data NET SECURITY NUMBER 2I g CLASS- TOTAL hOtIRL GROSS Y RATE AFhOUNT OR OF EMPLOYEE _tW I IFICAIlON 7110]7f11 1 7112 1 7f13 1 7/111 7f151 7116 HOURS OF PAY EARNED DEDUCTIONS.CONTRIBUTIONS AND PAYMENTS WAGES CHECK PAID NO. } Flours Worked Each Day F - WEEK S g.00 8-00 4.50 8.00 8.00 8.00 0.00 36.50 $85.64 PROJECT PROJECTS THIS ALL Federal Tax RlleCd care Saxe (Vacation Health& - -�lCIGUERRA. SDT CASEY Operating _ _ Holday Welfare Persian Engineer $303.91 5322.64 $43.70 $0-00 $0.90 $0.00 4 {Heavy& 0 0.00 2.00 0,00; 2.00 2.00 2.00 0.00 8.00 $112.1 Highway work}f - $2,523.44 1042 Group 3 Area 1 - $4,422,66 $4,022.Cre TrainingAdmin I Dues Travel& Total Fr;�9asSub Savings Other Deduct D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9-00 $0.00 " I S49.84 $0.00 $0.00 $0.00 $0.00 S250.97 $i,499.2 2 Other Deduction Notes:Training fee and CalSave►s contribution S U.r701 $.00 u.176 17-00 0.0{r 0.00 0.00 8.00 $48.50 PROJECT 'PRO PROJECTS T1-116 ALL Federal MeRdicare ref Tax Vacation Heaith&i WRIGHT,COLLIE SDI Holiday Welfare Pension PLUMBERI ^ -- - _ - _ _ 1 UNOERGROU $321.00 $152.85 $128.83 $21.98 $0.00 $0.00 $0.00 ND UTILITY O 0.00 0.50 0.00 0.00 0.00 0.00 9.40 0-50 $63.95 • PIPEFR TER $419.96 $2,014.01 Training Admen p Travel& $1,373.55 1046 Fliliges Sus Savings Other Tonal 0 0.00 0.00 0.00 0_00 0.00 0.00 0.00 13.00 $0_00 - - Deduct i $3.40 $0-00 $0.00 $0.00 $0-00 515.80 $640.46 r I Other Deduction Notes: T aining.e l I1 THIS ALLl r I S 0.00 $-00 8.00 8.00 1.50 0.00 0.00 25.50 $90.84 PROJECT PROJECTS Federal Tax Medicare STax Sal Holiday Health e YOUNG JlI Operating - Ho�day Welfare Pension 1 Engineer - - - 1 {Heavy& 0 0.00 2.00 2.00 2.00 2.00 0.00 0.04. 8.00 $119'6 $926 00 £39fi 28 5454.35 $56.99 $0.00 $0 00 $0.p0 �H!Highway work}I 0 $3,D84,t35 1047 Group 3 Area 1 �� _ $3,268.12 $5,240.20 Training Adn f Dues Travel$ Total Fringes Sub Savings Other 0 0.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 $0.00 Deduct. - $37.52 $0.00 $0.00 $0.00 $0.00 $321.93 52,155.5. 51 r Other©eduction Notes:Rating I SO': =STRAIGHT TIME *OTHER-Any other ried�ctians,cardfS6rr- Foim A-1-131 IN4w 2'tG) 0=OVERTIME bonG� or pay is whether or ndl included or required by pre�siWrg'rages dalern'i+eLnrtY must he a=OVERTITµ7E. Use exta srreel(5}if necessary. separately5 CERTIF1CATsu Ati35T be completed SDI=STATE DISABILITY INSURANCE ( reverse skies) dill California Department of 2022 Bowers 8 Bi�qu 213 Waterline Replacement Protect 12a.3a.8094 and 29-34.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM STATE OF C/LIFORNIA Page S�f STATEMENT DE COMPLIANCE CONTRACTOR f SUBCONTRACTOR CONTRACT NUMBER VINNCIGUERRA CONSTRUCTION, INC. r 20.20.8094 and 20.30.0281 I I FiRST DAY AIJD DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD 7/19/202.2 l do hereby cutify under penalty of perjury: 7116!2022 l (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 have been paid thei 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 that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions. (2) That thisemployer 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 forth therein for each rade rate conform with the work performed. (3; That anypayrolts otherwise under this control required to be submitted for the above paned are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the applicalab wages rates: (a) 0 Specified in the applicable wage deterniinalion incorporated into the contract; 0) n 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 mechanic conform with the work he or she performed. (4) That any Apprentices employed in the above period are duly registered in a bone fide apprenticeship program registered with a State apprenticeship agency. (5) That srinces benefits as listed in the contract: O. 0 Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed employee(s), except as noted below. 0) El Have been paid directly to the!isted errployee(s),except as noted below. (e] I I See exceptions noted below. I EXCEPTION CRAFT EXPLANATION REMARKS:Except for Training Funds for all Crafts paid directly to CAC. i l NAME(PLEASE PRINT.) (Austin Vinciguerra President SIGNATURE: r]ATF 8r212 022 On federally-forded projects, permissible deductions are defined in title 2S,Code of Federal Regulations,part 3,issued by the Secretary of Labor under the Copeland Act, (40 U.S.C.276c). Code). the willful falsification of ary of the above statements may subject the contractor or subcontractor to civil or crhrninal prosecution(See section 1001 of bee 18 and section 3729 of title 31 of the United States I i ADA Notice Fir individuals with sensory disabilities,this document is available in alternate formats.For information call(916)654-6410 or TDD(916)654-3880 or write Records and Forms GEM 2503 r enagement, 1120 N Street,MS--69,Sacramento,CA 95814, a California 2022 Bowers&Bijou 213 Wateriine Replacement Project!20.302094 and 20.30.8281 Department of industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM I Page 1 of a NAME OF CONTRACTOR:Vinciguerra Construction,Inc. CONTRACTOR'S LICENSE NO.:358838 J DR SUBCONTRACTOR: SPECIALTY LICENSE NO.: ADORES:P.a_Box 1$7,Sutter Creek.CIS 95665 !PAYROLL NO. • FOR WEEK ENDING: SELF-INSURED CERT: PROJECTOR CONTRACT NO.:20.30.8094 and 20.30.8281 I 14 7r'2312022 WORKERS'COMP: ,PROJECT AND LOCATFON:2022 Bowers&Bijou 2/3 Waterline Replacement Project,ELD CO (2) I (3) 4 DAY 1 sIMITIWITIFIS NAME,ADDRESS iS I WORK AND SOCIAL t , 1 CLASS Date TcrAL HOURL NET SECIJRITYIJUMSER oY1 YRATE GROSS AMOUNT WAGES CHECK OF EMPLOYE` [FICATIpN 7I17 17118 17119 7I2U}7Cd1 L7122 7f23 kw- FOR PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID I FOR NO. I Hours Worked Each Day WEEK I THIS ALL Federal FICA& State SDI Vacation S. t7.08 8.00 0.40 0.00 0,00 0.00' 0.00 8.00. W Holiday tNelfa$48.5o PROJECT PROJECTS Tax Medicare Tax We/fare e pension CALER.F PLUMBER/ - - - - I- 4 I UNDERGROU 0 0.60 2.00 0.40 0.00 8A4 0.00 0.00 2.00 563.95 $O.00 $39.18 $1.80 $5.63 $0.U0 T.0.00 $0.00 I ND UTILITY PIPEFITTER , $515.99 $515.90 Training Fringes Dues 95 Other Total • 39.51 1098 I Adm n i Travel& I 9e Sub Deduct. Q 0.00 0.00 0.00 0.00 0.00 0.00 0.00 D.00 $0.00 - $4.00 $0.40 3.0_00 $0.00 $0.00 $29.80 $76.39 Other Deduction Notes:Trairiir%o fee and G815avers contribution THIS ALL Federal FICA& State Vacation'Hearth&III S 0.00 8.00 6.00 8.00 8.04 8.00 0.00 40.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Flotiday Welfare Pension COWAN.THOMASH PLf1MBEii 1 UNO RBGROU S625.00 $243.42 $252.66 $35-00 $0.00 $0.00 $0.00 N❑UTILITY O 0.00 200 2.00 2.00 200 1.00 0.00 9.00 $69.20PFPEFfFT R $2D25.l32 1049 52,742.00 53,204,d0 Training F��I uesTr8 vrlgsOtFier Total Deduct. D 0.00 0.00 0.00 0.00 0.00 0.00 OM 0.00 $0.00 $19.60 $0.00 50.00 $0.00 $0.00 S22.40 $1.178'84 - _ Olher Deduction Notes:'raining lee tTHIS ALL I S 0.00 0.00 8.00 8.00 8,00 8.00 0.00 32.00. $48.50 PROJECT PROJECTS Federal MedicICAare Tax StateVacation Health e Tax SDI Holiday Welfare Pension LLiRIs PLUMBER 1 0 I UNDE uThrty RGROU 5391.00 $181.54 5169.90 $26.11 $0.00 50.00 $0.00 ND ERGRD D 0.00 0.00 2.00 2.00 2.00 0.50 0.00 6.50 $63.95 - PIPEfITTER 81,967,fi8 $2,391.08 Training Admire! DueS tTravel8 Total '57.604.53 1450 I Prlges Sub Savings Other Deduct. I D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 O 'S 1 .-�� l sts.4C S0.6o.00 SO.00 so.00 vits.Qp Srae.55 Other Deduction Notes:Training fee =5ST'RAfGI-{T RTIME TIME 'O7FlER-' 'oAier S=OVE deductions,eonlributions andkr payments whether or net included or required by prevaife we wage deletnatiens roust be separately Fsted. CERT!F'CATION MUST be oompie!sd Form r-1-13t{crew 2sa) Q=hollw IME SDI=STATE a]SAalLITY INSURANCE Use extra sheets)a necessary_ (See reverse side. Cliill Department of 2022 Bowers 8 Bijou 2/3 Waterline Replacement Project/20.30.8094 and 20.30.8281 lndustria!Relations PUBLIC WORKS PAYROLL REPORTING FORM (1) (2) [ (3) (4)DAY (5) (5) (7) Page ❑f fi I S (9) NAME.ADDRESS a NET AND E.SOCIAL c°� GROSS TOTAL( WORK Date WAGES SECURITY NUMBER CLASS Y RATEttot►� CSS AMOUNT CHECK OF EMPLOYEE rx [ IFlCAT1ON 7f17{ 718[7f19 17r'20 f 7t21 17122i 7123 rrWRS DEDUCTIONS, OF PAY DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS F4JD + [ _ FOR NO. Hours Worked Each Da WEEK THIS 1 ALL Federal FICA& State SDI Vaal on Health& S 0.00 0.00 0.00 8.00 8.00 8.00 0.00 24.00 $90.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension DAVIE]Sf; :.ee:. [ Operating - [ Engineer - $0.00' $247.04 $0.00 $35.52• $0.00 $0.00 $0.00 0 [ Engineer (Heavy 8 0 0.00 0.00 0.00 2.00 2.00 0.50 0.00 4.50 $119.6 Highway work)f l 0 Admire f TraveJ& �6 72 1051 I Group 3 Area t - S2.713.56 S3,266.24 Training Fringes Dues gob Savings Other Tat:J I Deduel, 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 j -__, 1 S31.92 50.00 $0.00 $0.00 50.00 S36.96 5319.52 I -,-r-- Other Deduction Notes:Trainino fee . THIS ALL S 0.00 0.00 5.50 8.00• 8.00 2.50 0.00 24.00 S48.50 PROJECT PROJECTS'Federal- Medicare Tax ICA& State SDI Holidayon Welfare &- Welfare Pension DEARMON,NICK PLUMBER f - D UNDERGROU 0 0.00 C 00 2.00 2.00 2.00 1.50 0.00 7.50 $63.95 SS285'00 52o9.18 $204.15 SW.08 $0.00 $0.00 $0.00 N❑UTILITY PIPEFlTTER Admiral Travel St S2,006.07 1052 51,643.63 $2,749.48 Training Frnges Dues Sub Sa ergs Other Total Deduct. 0 0.00 0.00 0.00 0.00 0.00 0_00 0.00 0.00 $0.O0 t $12.60 $0.00 $0.00 $0.00 50.00 $15.00 $743.41 - ---1--,_ 1 Cthet Deduction Notes: Training fee THIS ALL Federal FICA$ Stale SDI Vacation Health& f S 0.00 8.00 8.00 8.00 8.00 7.50 0.00 39.50 518.50 PROJECT PROJECTS Tax Medicare lax Pension j GRit=GQ.[3AVId _ Holiday Welfare PLUMBER 1 ' - 0 UNDERGROU $508.00 $218.27 $219.02 S31.39 $0.00 $0.00 50.00 ND UTILITy .0 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 $63.95 PIPEF ITTE R Ad min l - 51,878.52 1053 $2,427.35 $2,875.00 Training Fringes Dues Tr Su & SavirgS Otter Total Deduct, 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $19.00 s0.00 $0.00 50.00 50.00 521.80 $996.48 -____.- Other Deduction Notes'Dainino fee THIS ALL s 0.00 0.0o 8.90 0,00 5.40 0.00 0.00 24.00 $52.O0 PROJECT PROJECTS Federal Ta Mediicarre STax State DI Holiday Welfareelf LOPEZ TORRES, Hobady PCr iQr ALEJANDRO [ PLUMBER - 0 LINDERGROU 5242.00 5195.40 $17419 52a.+0 scum Soso S0.00 [ 0.00 0 p_ ND UTILIT0.00 2.00 2.00 0.00 22.00i1 00 6.00 56820 PIPEFFTTER nges Atlmin,' Travel g • S1.913.91 1054 - S1.663.20 52,572.24 Training Fri Dues Sub Savings Other Total [ Deduct. ❑ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $6.00 $12.00 $0.00 $0.00 50.00 S0.00 513.00 S658.29 -,-.1„.__ _.. Other Deduction Notes: Training lee S=STRAIGHT T€ME "OTHER-Any other dsd,eu r .canthbutiorts andor rs whether or nor included or recnxree a preuaieng wage delerrninatvr.n Peer be separately Form A-1-12.1 Ihiew 2-eQ O'04ERTR.IE i Y�r- J D=OVE RTiM IME Use extra sheegs)if necessary. p rotary fisted. CERTIFiCATe re MUSTeebe Comyleted SD!.STATE DISABILITY INSURANCE (See revPJ3e side) doll California Department of 2022 Bowers&Bijou 213 Waterline Replacement Project 120.30.8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3afa (1] (2) {31 (4)DAY (5) (6) (7) (8} S 1.1 T Vtr T F S (9) NAME.ACDRECS i r AND SOCIAL crJ I WORK Daft NET SECURfIY NUMEER 0 I CLASS TOTAL r RATE GROSS AMOUNT WAGES z ti x I (FICA-RON 7I17 1 7118 1 7/19 1 7120 1 7/211 7/22 1 7a'23 HOURS OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID CHECK OF EMPLOYES W I h FOR Hours Worked Each Day WEEK I THIS ALL S p-� 8.00 8.00 8.00 8.00 8.00 0.00 40-00 $52.00 PROJECT PROJECTS Federal MedicFICAare Saxe SDI Holiday Welfare > Vacation Health A Pe or-i 1}NETO PLUMBER 1 Chin UN€]!RGROfJ 5485.00 $259,21 $268,31 $37.27 $0.00 50.0D $0.00 0 ND UTILITY O 0.00 2.00 2.00 2.04 2.00 0.00 0.00 8.00 $69.20 PIPEFO TER 52.168.02 1055 - . r$2.633.60 $3,411.80 Training Admrn l Dues Tavel& Sayings Other Total Frnges SubDeduct D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 3 i l r $192 1,243.7 0 $0.00 $0.00 $0.00 $0.00 $193.99 a t 8 • I Other Deduction Notes:TiaininEL`ee and CalSavers contribution I THIS ALL Federal FICA& Stale Vacation Health 8 S 0.00 8.00 8.00 8.00 8.00 4.00 0.00 36.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension PASTEN I VELASQUE2, I PLUMBER! - 5366-00 $79$-1l? $180.59w $28-48 $0.00 SD.OQ $0.04 I UNEDERGROU 0 Q 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 563.95 _ I ND UTILITY PE) TER Travel& $1,810.38 1056 t - S2,257.60 $2.509.33 Training Fringes Dues Sub Savings Other Total I Deduct. 0 0-00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50.00 - - 517.60 $0.00 $000 50.00 50.00 $19.80 5798.97 I ❑ther Deduction Notes: Training fee I 5 0.00 0,00 0.00 3-00 0.00 8.00 0.00 16 00 $52.00 PRO IS ECT PROJECTS ALLTax al Ned pare FICA& STaxe SDI Vacation Health HoEday Welfare Pension PLUMBER r - 1 I UNDERGROiJ $50b_30 $2t1.f$ $207.48 $30.44 $0.00 $Q.pO SO.COI ND UTILITY O 0.00 0.00 0.00 2.00 0.00 0.00 0.00 2.00 $69.20 PIPEFITTEf? Admire I Travel$ &1,811.5p 1057 I - 3970.41T S2,T87.30 Training Fringes D�e' Sub Savings Other Total Op I Deduci- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 S0.00 - I $7.20 50_00 50.00 $0.00 $0.00 $20.20 $975.80 F s Other Deduction Notes:Training fee T- THIS . ALLr S 0.0o a.00 0.0o 0.vo a.00 4.00 0.00 28.00 t4B.50 PROJECT PROJECTS F�Tax I Med care FICA lf. $ lHoliday Tax So! vaoliday FWeJFdre elfh A sABI�Mai�sAN Pens con PLUMBER./ 0 I UNDEf2GROU - - $514.t]0 3220.70 $222.27 531.74 50.04� $0.00 $0.00 I ND UTILITY 0 0-00 2.00 2-00 0.00 2.00 0.50 0.04 6.50 563.95 - ND TTER $7,896.27 1059 I '. - $1,773.68 $2,906-98 Training Admire/ Dues Travel 8 Total Fringes Sub Swings Other Deduct, D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 • • $13.80 50.00 $o-00 $0.00 50.00 $22.00 $1.010.7 I r __. 1 - Other Deduction Notes:tr ininn frr S=STRAIGHT TIME 'OTHER-Any other deductions,contributions errdor Form A-1-121 } O=0011EL 1�fE PeYmenLs lase extra s eCtits]i r taryheiher or riot Ineiuded Of •red by D�Ve�n4 wage detarnrnai�rrs muss be separately rested. CERTIFICATION MUST be rnmpla[ed { O=OVER IME (See reverse side) SDI=STATE❑ISABIUJTY INSURANCE d l461114 California E3epsrtrttent of 2022 Bowers&Bijou 213 Waterline Replacement Project!20.30.8094 and 20,30.8281 industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM P e A of (1) (2) 1 (3) (4)DAY (5) (5) (7) o.., i 5 NI 1 T v., T F f S lB} csa NAME.ADDRESS LLo WORKWAGE i - NET SOCIAL o d- I Date TOTAL SECURITY NUMBER d xt C , HOURS Y p L GROSS AMOUNT DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS Pq#DS CHECK of EillPLOYE£ r x I WiCATION 7(17 7i 18 7I13 7120 7121 7f22 II 7f23 OF PAY EARNED NC. m I .. FOR Hours Waked Each Day WEEK THIS ALL Federal FICA& State SDI Vacation H ' Health 8 Pension S 0.00 8.00 8.00 8,00 8.00 7.50 0.00 33.50 $52.00 PROJECT PROJECTS Tax Medicare Tax Hakday Welfare STA • C R IMFI! PLUMBER( •" _ $6Q9.08 $238.16'$245.62 $3424 $0.00 $4.00 $0.00 0 I UND GRDU 0 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 $69.20 I Ni3IJTILlTY - $1.986.18 1080 P€PEFITTirR $2,607.60 $3,135.25] Training Admin f Dues Travel& Savings Other Total Fringes sup gDeduct. I D 0.00 0_00 0.00 OM0.30 0,00 0.00 0.00 $0.00 ___,, $19_00 $0.00 $0.00 $0.00 50.00 322.00 $1'149.0 2 Other Deduction Notes:Training lee THIS ALL Federal FICA& State Vacation Health&5 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS Tax Medicare Tax .." Hokday Welfare piOf1 TAYLOR, KRISTOFIfER PLUMBER I $494.00 $261.1$`$270.95 337.56 $0.00 $0.00 $0.00 1 UNOERGR4l1 a 0.00 2.00 2.00 2.00 2.00 0.50 0.40 8.50 $69.20 UTILITYUTILITY $2,353.51 1061 ND PiPEFfTTER $2,668.20 $3,437.80 Training Admin Trav Savings OtherTotal Fri � nges Sub Deduct. O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30.00 ~_, 2 $19.40 $0.00 $0.00 $0.00 $0.00 $23.60 $1' 9 Other Deduction Notes:Turning fee THIS ALL Federal FICA& State r SDI Vacation Health& S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $85.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension VINCIGUERRIL operating I - AUSTEN - r $1,037.0 - Engineer $437.74 $507.04 $62,94 S0.00 50,00 $0_00 I2 otal IH as work ! 0 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10.00 $112.1 33,877,30 1062 rghw Y ) I Group 3 Area 1 _ $4,546.60 $5,789.78 Training Admin Dues Travel Sub& Savings Other Deduct. I D 0.00 C.00 0.00 0.00 0.00 0.00 0.00 0.00 4 112. $0.00 ~ I r r 556.00 $0.00 $0.00 $0.00 $0.40 S67.78 $2, 8 Other Deduction Notes:Training fee THIS❑.oa B.Oo 8,00 8.00 8.00 8.00 0.00 40.00 5s5-6f PROJECT PROJECTSALL Federal MedicaCA re State Vacation Health& 1 VINCIGUERRA, - I ` SDI rtdiday Wetrare Per�sion CASEY Operating - j Engineer �' 3881.00 $400.74 $452.11 $57.63 $0.00 3,0.0o $0,00 4 IH;g(HeaVY waywork}! a 0.00 2.00 2.00 2.00 2.00 1.00 0.00 9.00 $112.Q 33.181.85 1063 I Group 3 Area 1 - - $4,434.50 $5,301.70 Training Fringest Dues Travel& Savings Other Total lDeduct, D 0.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 - I $54.88 30130 S0.00 30.00 50.00 Sail" $328.37 5 Other Deduction Notes:Trairina fee and CaIC rers contribution S=STRAIGI-T TIME 'OTHER-Any other daducuorK,conhihrgioos andpr payments whether er fa illciuderi or r urred Farm A-1-131(Mew 2�]j 0.DOTALE`IME Use extra sEfeeas]if necessary. by W '��'�9 wagedelsmgrtatror�must be completed scoot-eeesy Gstea. cERTfFICfSee re ec a nde (See rersrse side} Sial_STATE DISAEILTTY INSURANCE , California ail Depart nern of 2022 Bowers&Bijuu 2/3 Waterline Replacement ProfT Project/20.30.8G�4 and � .34.$2$1 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM f -� Page 5 of¢ (1) (2) I (3) (4)DAY (5) (6) (7) (8) - 5 hl T f W 7 F 5 (9) NAME,AODRE:S z$ NET AND SOCIAL 6Qc WORK Date HOURL GROSS AmOUNT WAGES SECURITY NUIs3EER =� CLASS- F001T]Rs (RATE EARNED OEpIJDTIONS,COh17Rt8llTEpNS AND PAYhtEl1T5 PAID CHECK OF EMPLOY x lFiGATlON 7117 718 7119 T{20 7721 7122 7i23 DE PAY FOR NO. to + Hours Warted Each Day WEEK r THIS ALL Federal FICA& State Vacation Health 3 S 0.00 0.00 0.00 0.03 0.00 7.00 0,00 7.00 $48.60 PROJECI PROJECTS Tax Medicare Tax SOI Holiday Welfare Pension WRIGHT CO PtUIvEBERI - UNf]ERGRflU $316.00 $161.33 $126.77 $21.76 $0.00 $0.00 $0.00 1 I a 0.00 0.00 0.00 0.00 0.00 0A0 0.00 0.00 $63.95 ND UTILITY $1,362.22 1067 PIPEFITTER Admin i Travel& Total - $339.50 $1,994.08 Training Fringes Dues sub Savings Other Deduct. D t 0.00 0.00 0.00 0.00 0.00 0.00 0.0d 0.00 30.00 $2.80 $0.00 $0.00 $0.00 $0.00 $16.00 5631.86 I ' L !k Other Deduction Notes: Trainir o fee' T _ THIS ALL Federal FICA& Slate SDI vacation Fiealsti 8 JJJ $ 0 8 S $.00 8.00 8.00 0.00 40.00 $90_64 PROJECT PROJECTS Tax twlecicaref Tar Hoftiday welfare PEf1$1pF1 I (YOUNG.JIM Dperatrng Si 026A Engineer $119.8 O $427.92 $496.64 $61.53 $0.00 $0.00 $0.00 I 1 (Heavy& 0 0.00 1.50 2.00 2.00 2.00 1.00 0.00 8.60 $3,298.68 1088 'Highway works/ 0 Admin 1 Travel d Total Group 3 Area 1 - _ $4,642.20 $5,656.90 Training Fri Deduct nges Dues Sub Savings Other _ i D 0.00 0.00 0.00 (1.00 0.00 0.00 0.00 0.00 3000 '$2I .358.2 I $54_32 $0.00 $0.00 30.00 $0.00 $345.13 2 Other Deduction Notes:Traininu fee and Cat$5vers contribution S-STRAIDHT TIME 'OTHER-Any other dedechons,contributions nd.'tr is O=OVERTIME a payments µhefhe a not included Or requ sed by prevailing wage Getcrnonatioe5s must be separately listed. CERTIFICATION MUST be completedForm q--1-137 New s-�] o_ �� E Use extra sheet€sl iif nec nary. (See reverse Side) SD!r STATE DSASILrrY NSURARICE 4 ili California Department2022 Bowers&Bijou 2I3 Waterline Replacement Project 120.30.8094 and 20.3o.8281 of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page fi of fs STATE OF CALIFORNIA STATEMENT OF COMPLIANCE 'CONTRACTOR I SUBCONTRACTOR CONTRACT NUMBER r VINCIGUERRA CONSTRUCTION,INC. 20,8Q.8094 and 20.36.S281 FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD 7117i202z 7123f2022 I do hereby certfy under penalty of perjury: (I) That t 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 have been paid their full weekly wages earned,that no rebates have been or wilt be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and that no deductiore 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 ail performed on this public works project,and that the classifications set forth 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) ri S• pecified in the applicable wage determination incorporated into the contract; (L) El Determined by the Director o`industrial Relations for the county or counties in which the work is performed;that the classification set forth therein for each laborer or mechanic conform 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 apprenliceship agency. (5) That fringes benefits as listed in the contract (a) [] H• ave been or will be paid to the approved pfan(s).funds(s),or program(s)for the benefit of listed employee(s),except as noted below. (bl [] H• ave been paid directly to the listed employee(s),except as noted below. (c) 7 See exceptions noted below. 1 EXCEPTION CRAFT EXPLANATION !REMARKS:Except for Training Funds for all Crafts paid directly to CAC. NAME(PLEASE TITLE Austin Vinciguerra President SIGNATURE:1 �� DATE !815/2022 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.the willful , falsification of am of the above statements may subject the contractor or subcontractor In civil or criminal prosecution(See section 1001 of title 18 and section 3729 of title 31 of the United States Code). 1 ADA Notice Far individuals with sensory disabilities,this document is available in alternate formats.For information coil(916)654_ 410 or TOD(916)6.54__3880 or write Records and Forms CEM 2503 Management, 1120 N Street,MS-89,Sacramento,CA 95814. Californiaail Department of 2022 Brewers&Bijou 2l3 Waterline Replacement Project124.30.8094Ond 20.3fl.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page i of a NAME OF CONTRACTOR Vinciguerra Construction,Inc. CONTRACTOR'S LICENSE NO.:35883$;OR SUBCONTRACTOR: ADDRESS:P.O.Box 157,Sutter Creek,CA,95685 SPECIALTY LICENSE NO.: "PAYROLL NO. FOR WEEK ENDING: SELF-INSURE❑CERT: PROJECT OR CONTRACT NO.:20.30_8094 and 20.30.8281 I 1$ 713012022 WORKERS'COMP; PROJECT AND LOCATION:2022 Bowers&Bijou 2f3 Waterline Replacement Project,ELD {1} (2) I (3) (4)DAY {S} (6) i7Y $) (9) o� SIMITIWITIFIS NAME.ADDRESS a NET AND SOCIAL =-o f WORK Date HOURL • SECURITY ER z I CLASS- TOTAL GROSS AMOUNT WAGES CHECK OF EMPLOYEE 3. • I IFICATION 7Y24 f 7125 1 7126 1 7127 1_7128 1 7/29 1 7/30 HOURS OPAY EARNED TE DE[JUCT]ONS,CdN7RlSUTIOfISAND PAYMENTS PAID NO. } FOR Hours Worked Each Day WEEK I. I S 0.00 8.00 8.00 8.0{} 8.00 8.00 0.00 40.00 $52.00 PROJECT I PROJECTS THIS ALL Flax E MedicFICA are State SDI Vacation Wetttt e8. holiday Welfare Pension PLUMBER i UNDERGRO 0 I IJ SS90A0 5232.24 5237-70 333.:0 50.00 $0.00 $0.00 A ND UTILITY 0 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10.00 569.20 PIPEFITTER I 51,942.46 l 069 S2,772.00 53.057-40 Training dmire s Dues Travel& Total Fringes Sub Savings Other ❑ed ❑ 0.00' 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 . 520.00 $0.00 $0.00 50.00 $0.00 $21.60 $1,114.9 L _11111 ___ 4 Other Deduction Notes:Trajnirp fee F I THIS ALL Federal FICA 8 • State SDI Vacation Ftealth 6 ' II S 0.00 0.00 8.0-0 8.00 8.00 8.00 0.00 32.00 $48.50 PROJECT PROJECTS Tax Medicare Tax Horuday Welfare Pension II CRA1G.CHR1S PLUMBER 1 '- ' - _ - -" 0 #LlNDERGROU 5305.00 $154.21 S133,36 $22.17 $0-00 $0.00 $0.00 ND UTILITY O 0.00 0.00 2.00 2.00 2.00 1.00 0.0O 7.00 $63.95 I ! PIPEFITTER •_ es$1.933-65 52,031.63 Training Fringes Du Travel Sarn9s Other- DTotal educt $1,401.09 1070 9 Sub I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 - $15.60 $0.00 $0.00 $0.00 50.00 515.80 5830.54 1 [ Other Deduction Notes:Tr ; THIS ALL Federal FICA& State 5❑I Vacation Health& } S 0.00 8.00 8.00 6.00 8.00 0.00 0.00 32.00 $90.64 PROJECT PROJECTS Tax Medicare Tax Pension DAVIDSON.BOONE 1Ho0day Welfare Operating r.� _ f Engineer $0.00 5315.42 $0.00 $4$.36 50.00 $0.00 $0.00 0 (Heavy& 0 0.00 2.00 2.00 1.50 2.00 0.00 0.00 7.50 $113.5 'H ighway work); 0 Adman i Travel 8 - - $3,762.38 1071 Group 3 i .. 53,797.48 $4.170.76 Training Fringes Dues Sub Savngs Other Total Deduct. • I D 0.90 0.00 0.00 0.00 0_00 0.00 0.00 0.9O $0.00 I 514.24 50.00 50,00 59.00 50.00 S47.90 $408.3$1 I Other Deduction Notes:Training fee S.STRAIGHT TIME 'OTHER-Any other dadueioexs,con4i6ution5 artdror O=DOUBLOVER Er1E aAymems whether Saeect s neceIXsrsary- M JET fs CcmpalEd FarmA-1-131(New 2�) a_ r not Isy PrevaiErtg wag*deiexrninatioru must pe Separate fisted. CERTIFICATION IFIC reverse!DOTA ETIME (] (See sloe} SDI=STATE DISABILITY INSURANCE icIR California Department°f Industrial Relations PUBLIC WORKS PAYROLL REPORT 2022 Bowers&Bijou 213 Waterline Replacement Project(20.30 8O94 and 20,30.8287 REPORTING FORM (1) [2} I {3} {5y {6J (4)DAY t 7T (g) - 's) 9e off 5 M W T F S NAME,ADDRESS = I I i AND SCCIAL .`^.9,c I WORK Date NET SECURITY NUMBER off{ CAS _ TOTAL Y RATE GROSS AMOUNT WAGES OF EMPLOYEE 2 i I IFICATIO 724 1 7125 1 71261 7227 1712E[7129 17130 HOURS OF PAY EARNED DEDUCTIONS.CONTRIBUTIONS AND PAYMENTS PAID crl NO.ECK I • FO Pour No?eed Each Day WEE K THIS ALL IS 6.00 0.00 0,00 5.50 5.00 7.00 0.00 20.50, 548.50 PROJECT PROJECTS F 7 ederal MeddicaFICAare Tax Vacation Health �� ate 561 HoSday Welfare Pension DFARMON,HICK , PLUMBER 1 ' UNDERGROU S204.00 5180.96: $166,39 326.02 $6.00 $0.00 S0.00 0 I ND UTILITY 10 0.00 0.130 0.00 2.90 2.00 0.00 0,00 4,00 563.95 - PIPEFITTER Adminl Travel& - $1.788-08 1072 $1.250.05 $2,377-45 Training Fnnges D1ea Sub Savings Otilar bedul • uct. D 0.0D 0.00 0.00 0.60 0.00 0.00 0.90 0.00 $0.00 $9-80 $0.00 $0-00 $0.00 $0.00 512.00 5589.37 1 Other Deduction Notes: a , , S 3.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 548.50 PROJECT THIS I PROJECTS FederalALL ax M Medicare Tay Taxe Vacation H!erf e GRIEGO,DAVID I _ SDI Ha&day Welfare PE^Slgn PLUMBER1 - 0 UNCERGROU $336.00 $153.93 $146.36 $23.57 $0.00 50-OQ s0.00 IMI I ND UTILITY 0 1.00 2.00 2.00 1,50 2_00 0.00 0.00 7.50 $63.95 FIC j PIPEFITTER _ _ Admin 1 Travel d 51,473.07 1073 .. _ 5Z,031.63 n2,159.53 Training Fri es Dues Savings Other edu I _ r'9 Sub Deduct. D 1.00 0.00 0.00 0.00 0.00 0.00 0.00 0_00 50.00 $15..80 $0.00 $0.00 $0.00 $0.00 516.60 5686.46 Other Deduction Notes:Training f§ THIS I ALL Federal FICA& State tVacation Heafth& l S 1.00 7,50 0.00 8.00' 8.00 3.50 0.00 27.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI dens pn LOPEZ TORRES, 3fanday Welfare jjjjjj0 I PLUMBER1 - r I UhJnEf¢GROU 6 S162.00 $169.74 $140.48 524.40 $0.00 $Q.00 $0.00 I ND UTILITY O 1'DU 0.00 0.00 0.00 2.00 0.00 0.00 2.00 $69.20 - ND TTER $1,542.40 52 235.20 Training Ad jo 1 Dios Travel& Tota]-51,722.18 1074 Fringes Sub Savings Other Deduct. I 0' LOO 0.00 0.00 0.00 4.00 0.00 0.00 0.00 50.00 511.60 $0.00 $0.00 50.00 50.00 515.40 $513.02 L Other Deduction Notes:Trainino few 1 T F - I 3 coo s.ov S.00 s_oa s.00 e.Gu V.94 40.00 $48.50 PROJECT PROJECTS F 21 Mee care, STax vacation)Heetth$ 11t OSQUEDA, l L SDi HvSday Welfare �a"sion ARTURD PLUMBER/ I - - D UNDERGROU 5367.00 5186.08 $1173,24 526.78 $0.00 50.00 $0.00 I l ND UTILITY 0 COO 2.00 1.50 1.06 2.00 0.00 0.00 6.50 S63.95 i PIPEFITTER - r Adtn n 1 Travel& $1,505.73 1075 52.355.68 $2.451.60 Training Fringes Dues Sub Savings Deter Total 1 Deduct. 0 G00 6.06 0.00 0.03 0,00 W0.00 0.00 0-00 50.00 . 1 ' $18.60 50.00 $0.00 50.00 $0.00 5192.79 S945.87 , Ocher Deduction Notes:_ ing feQ5r -,an t S=STRAIGHT R TJA[E 'OTHER-Any other dean bons.coal:c�ices aedrar paymens w:wetner or not in tided or re aired 6 Farm A_1_13f(New 2-44 o=DO.:TL IE 6SE ilsa e. ra slreefCs};f n -scary, v�evaere;wage deterr�asmons must he separately tts[ed. G£RTIFIGATIDN MUST be mn,pletuW SIJ1=STATE rasAMLrrY INSLRANCE (See reversr.sldeS n Department of 2022 Bowers&Bijou 2;3 Waterline Replacement Project 120.30.8094 and 20.30.8281 i. Industrial Relations PUBLIC WORKS PAYROLL REPORTI4 NG FORM Page 3 of (1) (2) {3} DAY { ) (5) (8) (7) (8) (9) 5 tyl 1 T 1 W TIF S i NAME,ADORES ?i 0o WORK NET AND SOCIAL _ti Date HOURL i WAGES CHECK SEGURIIY!«UM@ER o ow CLASS- -,-,HOURS Y DATE GROSS AMOUNT DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID OF EMPLOYEE 2 IFICATION i12d 7r25 7125 7/27 7125 7129 7130 OF PAY EARNED FOR NO. i Hours Worlced Eseh Day WEEK THIS ALL rS ).00 5.00 8.00 8.p0 8.00 0.00 0.00 32.00 548.50 PROJECT PROJECTS Fe-de Tao Medicare FICA& STaxe SDI Vacation Health& Holiday Welfare Pension ONETO,AAROIi PLUMBER 1 UNDERGROU $282.00 5158.07 5137.13 $22.87 $000 $0.00 $0.00 9 ND UTILITY0 0.00 2.00 2.00 1.C-0 1.50 0,00 0.00 8.59 $83.95 - $1,478.31 1139 PIPEFITTER _ $1,967.fi8 $2,095.58 Training Adrnln 1 Travel& Total Fringes Cues Sub Savings Other Deduct. D 0.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50.00 515Ae S0.00 501100 $000 $0.00 $16.20 5617.27 T Omer Deduction Notes:Training feg THIS ALL Federal PICA& State vacation Heat & S EGO 8-00 8.00 8.00 0.00 0.00 0.00 24.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension LNETO, f PLUMBER! �- CHRISTOpFER I UNOERGROU J $18dAO $153.95 $127.55 $22.13 $0.00 $0.D0 $O.Of] Q 0 0.00 2.00 2.60 2.00 0.00 0.00 0-04 6.04 368.20 51,423.45 1140 NDI UTILITY PIPEFITTER $2,026.40 Training Adrnies Dues Travel& Savings Other 57,6f3.20Total Fringes Sub Deduct. 0IIIM G.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 SO; $12.00 $0.00 $0.00 $0.00 $0.00 $115-32 $642.95 Other Deduction Notes:TraErlirlq fee I THIS ALL Federal , FICA& State Vacation Health& S COO 8.00 8.00 8.00 8.04 8.00 0.00 40.00 548.50 PROJECT PROJECTS Fax ;Medicare Tax SDI Holiday Welfare Pension FASTEN �1rELA5(2UEZ - PLUMBER I ' ELISIO UNC)PLUMB R S351.Od $193.37 $180.27 $27.81 $0.00 $0.90 50.00 0I O COO 2.00 1.50 1.00 'ISO 2.04 0.00 5.00 553.95 51,775.28 1141 ND UTILITY PIPEFITTER UTILITY TER Ad.-tin i 'Travel 8 7q}3E 1 $2,451.60 $2,547.53 Trading Frrages Dues Sub Savings DL*er GI000 0.00 0.00 0.00 0.00 4.00 0.00 0.00 $0.00 Deduct. l 519.20 50_00 50.00 $0.00 $0.00 $19.80 5772.25 -a Other Deduction Notes:Traininv.fee I 1 S otO a.oa s.oa 0.00 e.00 0.00 0.00 32,ea $02.00 Yt3 JTHISECT PROJECTS 1 ALL F fex Medicare Tax a1 FICAS V2eatian Health e 1 { SDI Holiday Welfare Pension PEREZ PLUMBER. ' UNOERGRgU $345.00 $160.53' 5139.08 523.08 5-0.00 50.00 50.00 1 O COO 1.50 2.00 1.50 1.50 0.00 0.00 6.50 569_20 i ND UTILITY 1 PIPEFITTER t ,_ $2,113.80 $2,113.80 Training Dues 51,430.7� 1142 Admini Travel& Savings ' Total Fringes sub Deduct ❑ ono 4.0a eve 0.44 0.00 0.00 0.00 0.00 $0.00 $15.40 50.00 50.00 50.00 S0.00 $15.40 5883.09 Other Deduction Notes: Train ino fee 5=STRAIGHT TIME 'OTHER-Any otter deductions,oontetnutens sedtn•peymento whether or not included or required prsva� Form 14-/-131 Mew��p 6=OVEi4;IME y 1ng wade determinations must 5e separately listed. CERTlF3CAttoM MUST�e cpnpleled [ } ❑_OVERTI TIME Use extra sheet(s)if necessary-. (See reverse side) $DJ=STATE DISABILITY LNSLrtANCE d, California Department of 2022 Bowers&Bijou 213 Waterline Replacement Project/20.30.8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of$ (1) (2) I (3) (4)DAY (5) (6) (71 (8) (9) I S I M ' T ^ W T F S NAME.ADDRESS =2 I - NET o❑ WORK AND SOCIAL eI Date HOIJRL WAGES o,dAgc� TOTAL GROSSAMOUNT SEGt1RtTY IiUMl3Eft a=w YRATE ❑EDUCTIONS.CONTRIBUTIONS AND PAYMENTS PAID CHECK Of EMPLOYEE =kw ) IFIGAT3f)1{ 7i24 7/25 7/26 7/27 7128 7129 730~ k OF PAY EARNED FOR NO I Hours Worked Each Day WEEK I { THIS ALL Federal FfCA& State Vacation Health 8. I S 0.00 5.$0 0.00 0.00 8.00 8.00 0.00 21.50 548.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Penson SAB IA MORGAN I PLUMBER 1 I UNDERGROU - - $528.00 $225.21 S228.29 532.38 $0.00 $0.30 $0-00 0 J ND UTILITY fl 0.00 D.00 0.00 0.00 2.00 2.00 1.00 5.00 S63.95 $1,929.98 1144 I PrPEFITTER 51,362,50 52.966.31 Training runA4mes Dues Travel& Swings Other Total Fringes sub f Deduct. I a 0.00 0.00 0.00 0.00 0_00 0.00 0.00 0.00 $0-00 $10.E0 $0.00 $0.00 $0.00 $i1,00 522.45 E$1,036_3 Y W Other Deduction Notes:Training fee I 1 THIS ALL Federal FICA& State Vacation Health& I $ 000 8.00 8.00 6.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare D't nSlOn STANFILL, I PLUMBER/ CHRI UNDERGROU $563.00 $223.69 $226.26 $32.17 S0.00 $0.00 $0.00 D O 0.00 2.00 2.00 1.50 2.00 2.00 0.00 2.50 $69.20 I ND UTILITY - - - • $1,878.88 1145 P1PEFITTER - -1 - $2,737.40 $2,945.00 Training Frrir-roes Dues 7r cvrahk 8 Savings Daher TOE aeducE- I D 0.00 0.00 0.00 0.00' 0.00 0.00 0.00 0.00 $0.00 $1,U5s_1 .00 50.it 50.00 $21.00 2 Other Deduction Notes:Training fee r THIS ALL Federal FICA& Slate Vacation, Health& I $ 0-00 3.00 8.00 3.(..'-'0 8.00 8.00' 0.00 40.00 $52.00• PROJECT 'PROJECTSi Tax Medicare Tax w SO] Holiday WarfarePension TAYLOR, i K STCPH� I PLUMBER/ '--�, $431.00 S240.14 5242.80 $24.53 i MOO $0.00 50.00 I UNt7ERGRpU 0 0.00 2.60 2.00 2.00 2.00 2.00 0.00 10.00 $69.20 ND UTILITY - - 52,190.53 1146 I PIPEFITTER - __� 52,772,00 $3,1$1.20 Training Adrnin) Dues Travel& Savings Other Iota! Fringes SubDeduct. G 0 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.0.00 $20.00 $0.00 30.00 $0.00 $0.00 $22.20 $970.67 I ()the:Deduction Notes:'Taiping fee THIS ALL Federal FICA R Stale Vacation Health&s COO o.ua V_DO a.eo ape &.V) 0.00 (-5.40 $85.84 PROJECT PROJECTS Tax Medicare Tax SD Holiday Welfare Pension VINCIGAUSDER RA,TIN I Operating - 1 Engineer 3701.00 5330.79 $364.04 547,57 50.00 50.00 50.00 2 (Heavy& 0 0.00 1.00 0.00 0.00 0.00 2.00 0.00 3.00 $112.1 r - 52.880.73 1147 Irllghway wprk} 0 Adrnin; Travel& Total I Group 3 Area 1 $1,021.42 $4,378.46 Training Fringes Dues Sub :Savings Other Deduct I 0 0-00 0.00 0.00, 0.00 0.00 0.00 0.00 0.00 $0.00 51,497.7 i I r 812.32 50.00 $0.00 $0.00 $0.00 554.32 2 Other Deduction Notes;Training fpe S=ST Mi0&T TIME 'OTHER-Any ether deducliona,Contribuiians and/or payments whethe;or not included or required by preraiii,g wage determinations must 4e s Form A-1-131 New:-S(}} 0=OVERTIME tfse extra 5lheei{S}'rF nece ary. ecaram1'festCd. Ct72T1FICJITION MUST ke C6mpkipxl ❑=OOU8L1 T�AE {See reverse side) 5Ol=STATE DLSAS ern-INSURANCE I €11R California Calif Department of Industrial Relations PUBLIC WORKS PAYROLL REPORT 2022 Bowers&I Bijou 213 Waterline Replacement Project/20.30_8094 and 20.30.8281 REPORTING FORM Page offi (1) {2} T [3} 4 I� I SIM1T1W1TI, F1 1 NAME,ADDRESS zz Si NET AND SOCIAL cd°k I WORK Date WAGES CLA55 _ TOTAL PAY GROSS AMOUNT DEDUCTIONS, PAID CHECK SECURITY hiJMEER $r x I !Fr-ATKIN 7.24 7r25 7E26 7{27 1 7128 712E f 7/30 OF PAY RNED j OF EMPLOYEE fit, I ,� FOR Na. Hours Worked Each Day WEEK TI-IIS ALL Federal FICA& Slate r I S 0.00 8.00 8.00 8.00 8.00 8.00 no 40.00 $85.64 PROJECT PROJECTS Tax Medicare Tax Vacation Health VINCd ERRP,EY I prating l SDI Holiday weEfare Pension Engineer $621.00 $318.08 $341.55 $45.73 $0.00 $0.00 $0.00 4 (Heavy& 0 0.00 1.00 2.130 2.00 0.00 2.00 0.00 7,00 $112.1 , I Highwaywo k}1 0 ��Admin I Travel& Total $2,620.30 114$ Group 3 Area 1 _ - $4,210,30 $4,210.30 Trailing Fringes Dues Sutr SB+ings Other Deduct_ II D 0.00 0.00 0.00 0.O0 0.00 0.00 0.00 0.00 $0.00 $1,580.5 I 552.64 $0.00 $0.00 50.00 $0.00 $263,16 0 . r _ I 1 _ Other Deduction Notes:'raining PP I THIS ALL Federal FICA& State Vacation Health&S 0.00 0-00 0.00 0.00 0.00 8.00 0.00 8-00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension WRIGHT-CO LiN I PL�IhIBf R f _ _' 11NOERGROtJ $343.00 $159.87 $138.19 522.98 $0.00 80,00 $0-00 i I ND UTILITY 0 0.00 0.00 0.00 0.00 0.00 2.00 0.00 2.00 563.95 $1.425.60 1 i52 YIPEFITTER Admin I Travel 8 Total I 5515.90 S2,106.53 Training .Fringes Dues Sub Savings akar Deduct. I d O 0.00 0.00 0.00 0.00 0.00, 0.00 0.00 0.00 50.00 I $4.00 $0.00 $0.00 50,00 $0.00 816.30 $680.54 _ Other Qeduclion Notes: Training feg I THIS ALL Federal FICA& State Vaeati n Health 8 SDI I S 000 8.00 8.00 8.p0 8.00 8.00 0.00 40.00 $90.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension YOUNG JIM I Operating Engineer 1 5898.00' $397.23 5442.23 $55.68 $0.00 80.00 $0.00 1 (Heavy& 0 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10.00 $119.6 'Highway work)/ 0 ,821.6p t5,120.Bp Training Admin Travel& g TotalS3•D22.83 1153 F- r Fr nges Sub$4i 1 Dues Sa.in s Other I I Group 3 Area 1• Deduct. I D 0.50 0,00 0.00 0.00 0.00 D.00 0.00 0.00 $0.00 $2,Q97.9 I $56.00 $0.00 $0.00 $0.00 80.00 5314.83 7 I Other Deduction Notes:Training lee and_cal$_av_m comnbution S=STRAIGHT TIME 'OTHER-Any o hgr deb c1ims,ooMri'wlix,s endror payments whether Pr not•u,d ded or uirec 0 -OVERTIME reG by prev2]ir g wage date nina5pas muss he s6pSrateFr fisted. CERTIFICATION MUST be completed Four.A-1-131;rrew 2,87] OVERTIME� Use extra seeet(s)if necessary_ (See reverse atic) SDI=STATE r)ISASIUTY 9tSURANCE Cali#omia Department of Industrial Relations PUBLIC WORKS PAYROLL REPO 2022 Bowers Bijou 2/3 Waterline Replacement Project f 2Q.30.809d and 20.30.8281 Page FORM Page f of STATE OF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOF;SUBCONTRACTOR CONTRACT NUMBER Vinciguerra Construction, Inc. 2130.8094 and 20.30.8281 FIRST ST DAY.4M)DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD 7/24/2022 713012022 I do hereby certfy under penalty of perjury: (1) That pa'or Supervise payment to employees of the above-referenced contractor on the above-referenced contract.All persons employed art said project for the above-referenced time period have been paid tieir',.rtl 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 that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions. (2) That:his 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 forth therein for each lade rate conform with the work performed. (3) That any layrolts 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 herein are not less that the applicabtewages rates: {a) 1---1 Specified in the applicable wage determination incorporated into the contract; (LI 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 taborer or mechanic conform with the work he or she performed, (4) That e'ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency. (5) That finges benefits as listed in the contract: (a Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed employee(s),except as noted below. (b J Have been paid directly to the listed employee(s),except as noted below. (c, n See exceptions noted below, EXCEPTION CRAFT EXPLANATION REMARKS Except for Training Funds for all Crafts paid directly to CAC. NAME(PLEkSEPRINT.) TITLE Austin Vinciguera President SIGNATURE- _ DATE Bi 11f2022 On federally-funced 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,the willful Ifatsification of ao 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 Fir individuals with sensory disabilities,this document is available in alternate formats.For information call{916)654-6410 or TOD(916)654-3880 or write Records and Forms Carty 2563 Minagernent, 1120 N Street, MS-89,Sacramento, CA 95814. ail Industrial ❑epartrnent of 2022 Bowers&Bijou 213 Waterline Replacement Project!20.30.8094 and 20,30.132811 Industrial#teiltions PUBLIC WORKS PAYROLL REPORTING FORM Page.$of fi !NAME OF CONTRACTOR VInc1guerrai Construction,Inc. CONTRACTOR'S LICENSE NO.:358838 ADDRESS:P.O.Box 157,Sutter Creek,CA,95685 IOR SUBCONTRACTOR: SPECIALTY LICENSE NO.: [PAYROLL NO. FOR MEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20_30_8094 and 20,30,8281 I i6 816R022 WORKERS COMP: PROJECT AND LOCATION:2022 Bowers&Bijou 213 Waterline Replacement Project,ELD (1) (2) I 01 (4)OAY ($)• (6) =7} (8) (a) SIM TIW [ T [ FIs NAME,ADDRESS 0.1 a I WORK NET AND SOCIAL 9 I Date TOTAL ttOuRL GROSS AMOUNT WAGES SECURITY NUMBER 9�� CLASS- HOURS Y RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID CHECK OF E�IPtOYEE I IFICRTION 7131 Slat 8K12!8P03 8104 $fps 1 8J06 OF PAY FOR NO. Hours Worked Each Day WEEK I THIS AU. Federal FICA& Stale SDI Pension Health 8 Pension , - I S 0.00 8.00 8.00 8.00 8.00 2.00 0.00 34.00 $52.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN,THOMAS I PLUMBER) - $431.00 $181-69 5169.98 $28.11 $50.00 $0.00 $0.00 0 I N Dt UTILITY I 0 0.00 2.00 2.00 2.00 2.00 0.00. 0.00 8.00 569.20 -I ND UTILITY . Adrnin/ Travel F Total $1,564.94 1158 I PIPEFITTER $2,321.60 $2.390.80 Training Fnrtges Dues Scb Savings Other Deduct- ! 3 0.0D 0.00 0.00 0.00 0.00 0.00 0.00 0-00 $0.00 $16.80 $0.00 $0.00 $0.00 $0-00 $1720 $825.85 ` I _ r r Other Deduction Notes:Training fee THIS ALL Federal FICA A Slate Vacation Health& I ,S 0.00 0.00 8.00 8.00 8.00 2.50 i 0.00 26.50 $48.60 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension GRAIG,CHRIS I PLUMBER! ° $253.00 $136.40 $109.64 $19.62 $0-00 $0.00 $0.00 0 I UNQERGROU ,0 0.00 0.00 200 2.00 2.00 0.00. 0.00 6.00 $53.$5 - - $1,264.49 1157 ND UTILITY Adrnin/ Travel& Total I PIPEFITTER , $1,668.95 $1,796.85 Training Frn9es Cues Sub Savings Other Deduct. I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 I $13.00 $0.00 $0.00 $0.00 $0.00 $13.80 5532-36 Other Deduction Notes:Training fee I THIS ALL Federal FICA& State Vacation Health 8 I 5 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $90.64 PROJECT PROJECTS Tax Medicare Tax SD! Holday Welfare Pension DAVIDSON.BOONE 1 Operating - I Engineer $0.00 S296.19 $0.00 $42.58 $0-00 50.00 $0.00 0 (Heavy& 0 0.00 2.00 2.00 1.50 2.00 0.00 0.00 7.50 S119.6 0 53.532.95 1158 IH3 Areavey )7 ' S3'797'48' $3,917.98 Trsning Adnin 1 Dues Traver` Swings Other Total Group Fringes Sub - Deduct. I 0 0.00 000 0-00 0.00 0.00 0.00 6.08 0.00 E4.48 ^ $4424. $0.00 50.00 WOO $0-00 54536 $304.13 - , Other Deduction Notes:Training fee S=STRAIGHT TIME 'OTHER-Any other deductions,ccrdrib,aons andtor payeerrls metier or not included or reGu-.red ey preva,bng vrege determinations must be separately isted. CERTIFICATIOII MUST be completed • Form Art-13;{He r 2�0) 0-OVERTe iE Use extra sheet€sl a necessary. See reverse sHe} O=DOl18lEfIME 501=STATE DISABILITY INSURANCE dri California Department of Industrial Relations PUBLIC WORKS PAYROLL REPORT 2022 Bowers Bijou 2/3 Waterline Replacement Project 12Q.3Q.$Q94 and 20.30.8281 REPORTING FORM Page Z1) (Z) I !31 (4)DAY (5) (5) (7) S M T 1 W T F S C8} [9} NAME.ADDRESS ' =4 I WORKNET AND SOCIAL $ar Date TOTAL FfRATE GROSS AMOUNT WAGES SECURITY FI<} {gER ox - Y RATE CLASS- EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID CHECK OF EMPLOYE 2 j IFECATIDN -7131 8101 f 8i02 8103 8iO4{ 8/05 8I06 HOURS OF PAY FOR Hours Worked Each Dar WEEK I THIS ALL Federal FICA& State Vacation HeaIL1&S MO 8.00 8.00 8.00 8.00 0.00 0.00 32.00 548.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension 1 GRIEGQ,DAVia f PLUMBER 1 t - 1WI UNLIEIRGRi51J • $440.00 S197.05 $190.68 $26.34 $0.00 $0.00 SO.D0 0 -0I ND UTILITY 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 563 os - 5i,7 33.95 7160 RIPEFETTER Admin Travel& Total j $2,083.68 $2,596.06 Training Fringes Dues sub Savings Other Deduct. I D 0_00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 - 318.00 $0,00 $0.00 50.00 50.00 $20.05 S878.11 t_ Other Deduction Notes:Training lee I .. THIS ALL Federal FICA& State Vacation Health& ! j S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension LOPEZ TORRES. ALEJANDRO PLUMBER/ " 1 UNDERGROU 5741.00 $163.15 $131,68 523.46 $0.00 $0_00 54.00r 0 I ND UTILITY 0 0.00 2.00' 1.00 2.00i 1.00 0.00 0.00 6.00 $59.20 - _ $1,573.57 1161 PlPEFlTTER - .. - 52,079.20 5?,14$.d0 Training ddmin! Dues Travel$ ,Savings Oth Total Fringes sub er Deduct I D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 S0.00 $1520 $0.00 $0.90 S0.00 30.00 515.60 $474.89 �• r I Other Deduction Notes: ini Fee THIS ALL Federal FICA& State Vacation Health& I S U O0 8.00 8.00 6.00 8.00 [Lop 0.00 32.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDIHoliday Welfare Pension AiOSQDEDA I PLUMBER; -.. : a :■ I UNDERGROU $290.00 $161.50 5740.38 523.22 $0,00 $0.00 $0.00 • 0 I ND UTILITY 0 0.00 2.00 2.00 2.00 2.0D 0.00 0.00 8.00 553.95 ' 51,3Z Z.46 1162 Ad j PIPEFITTER , _, _ 1 52,063.60 S2.127.55 Training; n`�'J Dues Travel& Sav;rgs Other Total Fringes SubDeduct. I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 - 516_00 $0.04 $0.00 50.00 50.00 5189.99 $805.09 Other Deduction notes:T!a tng_tee and rqIL,5jiineW I - - THIS ALI. I o.00 a_oo S.00 8.00 8.00 0.00 0.00 32.60 543.5:1 PROJECT PROJECTS Federal MedicareCA& Slate SDI v8Caii-on Health 8 Penaldr, ONETO,AARON I IyaEd$y WelFare PLUMBER 1 - .� " ( UNOERGR011 5363.00 5184.68 $171.38 328.35 30.00 $0.00 $0.00 0 l ND UTILITY O 0.00 2.00 2.0E} 2.00 2.00 0.00 0.00 $.00 $63,95 4 PIPEFITTER $3,68$.57 1163 • 52,063.64 82,434.ii3 Training ' Dues Travel& Savings Other TO tai FringesSub Deduct. D 0,00 0.00 0.00' 0.00 0.00• 0.00 0.00 0.00 $0.00 1. I 516.00 $0.00 $0.00 $0.00 50.00 516.60 $762.21 Other Deduction Notes: Trani S=STRAIGHT TIIIE *OTHER-Any c her reductions,oorNr�ati0n8 an4Jar peymanis whether 0r net in-Judea°r required 6y Ors Form A-I.131{New:EO D=D0LIBLETIrang wage detem nations oust be sEpar�ery I�ucd. CERTIFICATION M be } r7=ODUBLETIlrtE Use exdra sAeer[s}it rsecessary. rseT earrrpietsfl (See reverse side) St}i.STATE❑r$AG91111'Y lreSFJP..4NC.E dilk California DepaHment of 2t722 Bowers&Bijou 2J3 Waterline Replacement Project 120.3a.8D94 and 20.30.t32I3i Industrial Relatons PUBLIC WORKS PAYROLL REPORTING FARM Page 2 of )1) r (2) I (3) - (4)DAY y_ 5) (6) (7) (8) {9) I S J fr1 T W T F S NAME,ADDRESS ?1 F NET AND$00IAL agn I WORK Date TOTAL H❑uftL GRO55 Wv4❑Jh T WAGES SECURITY NUMBER gx CLASS Y ATE DEDUCTIONS,CONTRIBUTIONS AHD PAYMENTS pplO CHECK OF EMPLOYEE � IFICATION 7r31 8f01 $b02 8 03 8.r04 Sinn Si06 KCUR$ OF PAY EARNED FOR NO. I Hours Worked Each Day WEEK THIS ALL Federal FICA& Stale SDI Vacation Health& I 5 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension ONETO, I PLUMBER I + _ . I UNDERGROU S398.00 5228.96 5227.84 S32.92 $0.00 $0-00 $0.00 1111111111 0 I ND UTILITY P1PEF1TTER 0 0.00 2.00 2 00 2.00 2.00 0.50 0.00 8.50 $69.20 - - 51,954.37 t 164 I $2,668.20 53,044.20 TrainingAdm Travel& Total Fringes Dues Sub Savings Other Deduct. t 2 0.00 0.00 0.00 0.00 0.00 0.U0 0.00 0.04 SOAP $1.059.8 519.40 $0.00 50_00 $0.00 $0.00 $172.11 _ 3 Other Deduction Notes:Traininq{ke and CalSar2_ ontri6+tiara THIS ALL 'Federal FICA& State S 0.00 8.00 8.00 8.00 800 000 0_ . .0SI 32.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Vacation & Holiday Health earthWelfare Pension FASTEN _ _ _ VELASOUE2, PLUMBER! $244.00 $:59.07 $134.40 522.87 $0.00 $0,00 $0.00 EL ISIO U N QERGROU 0 0 4.00 2.00 2.00 1.50 2.00 4.00 0.00 7.50 $63.95 - - $1,519.04 1165 ND UTIL€T!` P€PEFITTER _ $2,031.[.3 $2,f}35.58 Training Adrrein 1 Dues Trove!& Swings Other Total Fringes Sul] Deduct] D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50.00 • S15.80 S0.00 $0.00 $0.00 50-00 $16.20 5576.54 Other Deduction Notes:Traigtoolee I THIS ALL Federal FICA& State Vacation Health 8 I S 0.00 3.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.00 PROJECT PROJECTS Tax Medicare Tax S01 Holiday ;'4'eilare Persian PEREZ,SER„10 i PLUMBER/ UNDERGRCU 5566.00 5230.9-6 S233.28 533.21 $0.00 50.00 $0-00 1I 0 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 $6920 i $1,955.77 1166 ND UTILITY 1 PIPEFMIER • _ „ _ $2,217.60 $3.949.64 Training Adm9 1 DuesTrent, Sav1. s 01f1er Total Frn es Sub DeOUtt. I IJ 0.00 0.00 0.00 0.00 0.09 0.00 0.00 0.00 $0.00 51,084.8 L S10.00 50.04 $0-00 $0.00 $0.00 $21.d0 7 Other Deduction Notes:TraioiLg./9± I THIS ALL Federal FICA& State St7l Vacation 3-ieatlh& pensi x, I s 0.00 s.o0 s.ad e.00 0_9q 4,00 4.44 24.00 548.50 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare SABIA,MOKANI I PLUMB-ER I ,- 1 UNDERGRDU 5415.00 5189.08 $179.99 $27_19 $6.00 $0.00 50.00 0 ND UTILITY 0 COO 2.00 2.00 2.00 0.00 0.00 0.00 6.00 563.95 - - $1,660.39 1168 Total 1 PIPEFITTER $1.547.70 S2,491.10 Training Fringes Dues Trove!& Savings Other Deduct. I ub I D 0.00 0.00. 0.00 0.00 0.00 U.00 0.00 0.00 $0.00 I r a t $12.00 $0.00 $0.00 50.00 S0.00I $19.a5 $830.71 Other Deduction Notes:Training fee 0'SSTRAIGHT TIME 'OTHER-Any ocherde4ucions,opny-itu Duns andlor payments wnetfer oc riot i0ck ded or required Ley prevzdrng wage derermMritns muss be separately listed_ CERrIFICAT ION HIM be aorrpreted Fprrn.4-1-431 New?�D} p-�D ETIM5 Use extra sheer(*)if r acy. (See reverse sidel SDI=STATE DISA31LITY INSURANCE idIN California Department of 2022 Bowers&Bijou 213 Waterline Replacement Project/20.3p.8094 and 217.3p.$281 IndustrialI2alatlons PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of a (1) (2) I (3) (4}DAY (5) (6) (7) � (g) (s) 5IMIuIw1TTF S NAME,ADDRESS AND SOCtAL tit' [ WORK te NET SECURITY [ I IG T1A t31d 7131 &fTT 18J021 8 p3 I$/04 85p5 I g�fi�HER PAY GROSSWAGES R AMOUNT DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PA.tQ CHECK [ FOR NO. OF EMPLOYE. g a Hours Worked Each nay WEEK t THIS ALL Federal FICA& Slate SDI Vacation Health& Pension S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare STANFILL, I PLUMBER i - - - �•: -I e-_ IJMC]ERGROU $564.00 5223.85 $228.49 $32.19 $0.00 SO-W $0.00 0 ND UTILITY O 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 $fi9.2U r$1,879.65 1169 [ PIPEFffTER $2,217.60 $2,947.28 Training Fringes Dues Travel&ub Savings Other Deduct 0 0.00 0.00 0.00 0.00• 0.00 0.00 0.00 0.00 S0.00 $1,067.5 I r $16.00 $0.00 $0.00 $0.00 $0.00 $21.10 s Other Deduction Notes_ jr fee THIS ALL Federal FICA& State Vacation Heakh 8, I S 0.00 8-00' 8.00 8.00 8.00 0.00 0.00 32.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension TAYLOR, _ KRISTOPH [ PLUM ER1 ^$338.00 $207.25 $198.81 $29_$0 $0.00' $0.00 $4.04 1 [ NO UTILITY 0 0.00 2.00 2.00 2.00 2.00 0.04 0.00 8.04 $08 20 [ NO UTILITY • PIPEFITTER Adman I Travel& Total $1,93T.15 11 TO $2,217.r $2,727.80 Training Fringes Dues Sub Savings Other Deduct. [ 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 _ - [ $1fi.00 $0.00 $(3.Op $O.IHI $0.00 $15.80 $790.65 Other Deduction Notes:Training fee I THIS ALL Federal FICA& State Vacation Health& I S 0.00 8.00 8.00 8.00 8.00 2.00 0.00 34.00 $85.64 PROJECT PROJECTS Tax Medicare Tax SD1 Holiday Welfare Asian VI NCIGU ERRA, AUSTIN I Operating _ I Engineer $681.00 $292.58 $312.95 $42.07 $0.00 $0.00 $0.00 2 [ (Heavy& 0 0.00 0.00 2.00 2.00 0.00 0.00 0.00 4,00 $112.1 - Highway work)!' 0 Adman f Travel& Total $2'596'12 till I Group 3 Area i - $3,360.16 13,874.00 Training Fringes Dues Sub Savings Other Deduct. [ 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 00 $1,2T7.8 [ $42.56 $0.00 $0.00 $0.00 $0. $49.28 8 Other Deduction Notes: Training Egg I l - r. a.00 n_ao a.00 s.00 s.oa 4.50 u.vo 30,50 $if .BM aRCfSGT PROJECTS FederalS ALL rFFICA& Stale 541 aCation Health 8 Pension VfNCIGUERRA, Holiday welfare CASEY I Qprxa5n9 [ Engineer $f 12,1 $836.00 $386.40 $432.94 $55.58 $0.00 $0.00 $0.00 4 IH huge work)/ 0 0.00 2.00 2.00 2.00 2.00 0.00 0.00 8.00 4 - - $3.084.54 1172 Highway I Group 3 Area 1 - - - $4.022.66 $5.110.91 Training Adman J Fringes DUETS 9s Sub Travel 8 Savings Other Deduct Total 1.[ D 0.40 0.00 0.00 0.00 0.00 0,00 ❑.00 0.00 $0.90 ' [ $49.84 $0.00 $0.00 $0.00 Se-00 $315.17 /2'026.3 . d 7 Other Deduction Notes:Training fee and CalSa'e S=STRAIGHT T1k 'OTHER-Any otherdedreuuns.contributions anaier payments whether or dot included or ing wage deterrnheAyns ma be rate fisted_ CERTIFICATION Form A t_331(Dew:-8o a=OVERTIATE required try arevai separately QSS tSI be cornpieted a=DOUBLET-ME Use extra sheet(slif necessary,. ISee reverse side) sOt=STATE DISA81l1TY INSLA2ANCE dial Dep California Ciepartment of 2422 Bowers&Bijou 213 Waterline Replacement Project 120.30.8094 and 20.30.8281 IndustrialRefatians PUBLIC WORKS PAYROLL REPORTING FORM Page 5off (1) (2) 1 (3) (4)DAY (5) (6) (7) (8) 9 S I M I T I W 1 T I F S ] NAME.ADDRE6S aA I WORK NET AND SOCIAL a Date TOTAL. RATE GROSS AMOUNT WAGES SECURITYt�UMEER y s I CLASS- Y RATE CHECK OF EMPLOYEE w � IFICATION 7/31 6/01 1 8/02 8f03 1 8/04 8.r05 Sf06~ HOURS OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID FOR NO. ] FOR ".ours Wonted Each Day WEEK .L _ THIS ALL Federal FICA& State 5D1 Vacafvn Health8 PeriSion , I S 0.00 0.00 8.00 0.00 0.00 0.00 0.04 6.00 $48.50 PROJECT PROJECTS Tax Medicare Tax Hcadav Welfare PLUMBER 1 , $100.0t} $7$.94 $31.47 $11.07 $0.00 $0-00 $O-00 1 ]L1H[]ERGROU 0 011 .00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $63.96 I AID UTILITY - $7$6.34 1 17Fj ] PIPEFITTER $515.90 $1,013.82 Training Agin Dues Travel Savings Otr er Total Fringessot, _ 9 Deduct, 0I 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $a.GO - 54.00 1 $0.00 $0.00 R T n J_Qfl $0.00 58.rN3 $227,4S I I Other Deduction Notes:Trainino 113e THIS ALL Federal FICA& Stale 56! Vacation Health& I S 0.00 8.00 8.00 8,00 0.00 0.00 0.00 24.00 590.64 PROJECT 'PROJECTS Tax Medicare Tax Holiday Welfare pension ] Operating -_ Engineer $452.00 $241.39 $247.22 $34.71 $0.00 $0.00 $0.00 1 ] {Heavy& 0 0.00 2.00 2.00 2.00 0.00 0.04 0.00 6.00!iIll $118.6 r rlighway work}; 0 Admin 1 Travel& 52.420.64 1177 I Group 3 Area 1 - E $2,1392.9$ $3,191.98 Training Fr ngcs Duas Sub Savings Other Tosar 3 - - Deduct. I 0 fl.00 0.00 0.00 0.00 0.00 {l_00 0.00 0.00 $0.00 I _ S?3-5t3 $0.00 $0.00 $0.00 $0.00 $196.00 51.171.2 Other Deduction Notes:Training fee and CalSav-rss8ntr;hulion S=STRAIGHT TIME 'OTHER-Any other deducnans.contribulans andlor peyrnarnss whelher or not included or 0-QVERTI}TE required by xeva+bng wage d9t� :natiw must u st be separately Lsted. CERTIFICATION MUST be completed Form A-4-1 31(New e'-9pj =OVER E1lu1E use extra sheets}if necessary, iSee re'+evse side} SDI=STATE DISABIJJTY lNSLrRA1JCF dinCalifornia Department of 2022 Bowers&Bijou 2l3 Waterline Replacement Project 12 .3Q.8094 and 2(3.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page s of 6 STATE OFCA.LIFORh]kA ' STATEMESIT OF COMPLIANCE CON-TRACTOR ISUBCONTRACTOR CONTRACT NUMBER 1 Vinciguerra Construction,Inc. 20.30,8094 and 20.34.9281 FIRST DAY AND DATE OF PAY PERIOD `LAST DAY AND DATE OF PAY PERIOD • 713112022 816(2022 I do hereby certify under penalty of perjury. (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 have been paid'heir full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf at said contractor from the full weekly wages earned by any person and that no dedu tiors have been made either directly or indirectly from the full wages earned by any person other than permissible deductions. (2) That Iris employer has conipiied 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 forth 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) ❑ Specified in the applicable wage determination incorporated into the contract; (b) El 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 mechanic conform with the work he or she performed. (4) That any apprentices employed in the above period are duly registered in a bone{de apprenticeship program registered with a State apprenticeship agency. (5) That fringes benefits as listed in the contract: (a) ❑ Have been or will be paid to the approved plan(s),funds(s),or program(s)for the benefit of listed ernployee(s),except as noted below. (b) 1] Have been paid directly to the fisted employee(s),except as noted below. (c) El See exceptions noted below. EXCEPTION CRAFT EXPLANATION REMARKS.Except for Training Funds for all Crafts paid directly to CAC. NAME(PLESSE PRINT.) TITLE r Austin Vinciguerra r President 51GltdTtlRr G� DATE idtj80 t 112022 On federally- ded 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.276e),Also,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 3729 of tide 31 of the United States Code). ADA Notice Por individuals with sensory disabilities,this document is available in alternate formats.For information cart(916)651 6410 or TDD(916)654-3880 or write Records and Forms CEM 2503 Management,1120 el Street,MS--89,Sacramento,CA 95814. d l California Department or industrial Relations PUBLIC WORKS PAYROLL REPO 2022 Bowers&Bl}Ou 213 Waterline Replacement Project 12020.8094 and 20,30.8281 REPORTING FORM Page t of a NAME OF CONTRACTOR:Vinciguerra Construction,Inc. CONTRACTOR'S LICENSE NC.:358838 IOR SUBCONTRACTOR: ADDRESS:P.O.Box 157,Sutter Creek CA 9$685 SPECIALTY LICENSE NO.: 1PAYR0LL NO. FOR WEEK ENDING: SELF-INSURED CERT: PROJECT OR CONTRACT NO.:20.30.8094 and 20.30,8281 I 17 8)1312022 WORKERS'COMP: PROJECT AND LOCATION:2022 Bowers 8 Bijou 213 Waterline Replacement Project,ELI) (1) (2) I-- - (4)DAY (5) (6) (7) - lg} ox • , simIT HIT ) cis (g) NAME,AWRESS o WORK jj NET AND S401AL 't o- 1 Date NOURt SECURITY 1it11N6ER ° CLASS- - TOTAL PRATE GROSS AMOUNT WAGES CHECK OF EMPLOYEE z=w I IFICATION 8'07 6)08 8/09I8110I8/1118f12 8113 EIOURS OF PAY EARNED ° DEDUCFIONS,CONTf2i8LITId1V$ANDPAYMENTS PAID I FOR Hours Worked Each day WEEK 1 THIS ALL Federal FICA& State SDI vacation Health&P f S 0.00 8.00 8.00 8.00 4.00 0.00 0.00 28.00 552.00 PROJECT PROJECTS Tax Medicare Tax ' Hoiday Welfare ensign COWAN Ti OM I - PLUMBER.1 $283.00 $134.21 $f06.61 579.30 $0.00 $0.00 $0.DQ UNDU ITY 0 0.00 1.50 1.50 1.50 0.00 0.00 0.00 4.50 $69.20i f ND UTITILITY PIPEFITTER $1,767.40 $1,767.44 Training Admin I Du5S Travel& cauin s Other Total $1.211.28 1179 Fringes Sub 4 Deduct, I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0-00 1 $13,00 $0.00 $0.00 S0.00 $0.00 $13.00 $558.12 Y Other Deduction Notes:Training leg I THIS ALL Federal FICA 8 State 501 Vacation Health 8 j S 0.00 0.00 8.00 8.00 8.00 8.00 0.00 32,00 $48.50 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension CRAIG,01-IFS , PLUMBER) ' - - - UNDERGROU $262.00 5139.83 $113.85 $20.07 $0.00 $0,00 $0,00 0 i ND UTILITY 0 0,00 0,40 1.50 1,50 1.50 0.00' 0+.00 4.50 $63.95 PIPEFITTER . $1,289.63 1181) Admire] T:awei 3 Total $1,839.78 $1,830,78 Training Fringes Dues Sub Savngs Omer Deduct. D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 f S 14.80 $0.00 50.00 $0.00 $0.00 514.60 5550.15 Other Deduction Notes: jnin0 fee j THIS ALL Federal FICA& State Vacation Health& I S 0.00 8.00 0.00 8.00' 4.00 8.00 0.00 32.00 $90.64 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension DAVIDSON-,30011E 1 Operating - ! Engineer $0.00 $323.37 50.00 $46.50 $0.00 $0.00 $0.00 0 , (Heavy& 0 0.00 2.00 0.00 1.50 1.50 0.00 0.00 5.00 S 119.6 Highway work;f0 Admin r Travel& 53,857.2$ 1181 I Group 3 Area 1 T - 53,498.48 $4,275.88 Training, Dues iota] Fringes Sub 5avngs Other Deduct. j 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -7 00 80.00 - - - l - -- Se1.44 $0.00 $0.00 SO-00 $0-ail' 548.72 $418.59 ' Other Deduction Notes: Tyr iron _fgg r S=OVRTSTRAIGHT TI 'OTHER-Any other deductions.dorv:ibu[io.is an[L or Ls ref r}� required 4=OVERTIME payments*nether or not req by prevailing wgge determinations must be sg Farm A-7-I (Hew 2-eo) p=DOURLETIME Use exl a Ol eet{5)if nBGaseery. pa afety 5 ste6. CERTIFiCA3e OUST 6e cornpVeted 501.-STATE DISABILITY INSURANCE (See referee aide) California Department of 2022 Bowers&Bijou 2/3 Waterline Replacement Project/20.30.8094 and 20.30.9281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2 of f {1' (2) 1- {3) (4)DAY f5) i6) I (7) fa) (9/ S t.1 T W T F S NAME,ADDRESS 2 z I .a o WORK NET AND SOCIAI a IDale TOTAL +RATE CHECK SECUR#TY NUKBEfZ a CAS r RATE GROSS AMOUNT WRGES DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID OF EMPLOYEE ~3 I IFICATIOt $107 8108 8109 $110 8i11 8112 &'13 ttOURS OF PAY EARNED FOR I Fours Worked Each Day WEEK THIS ALL Federal FICA& State Vacation F{ealth& I S 0.00 0.00 0.00 8.00 8.00 8.00 0.00 24-00 $48.50 PROJECT PROJECTS Tax Medicare Tax ; 5GI Hol=day Welfare Pension GRIt G0 DA I PLUMBER 1 I UNC)ERGROU 5157.00 5102.89 $64.74 514.7E 50-00 $0.00 S0.00 0 I ND UTILITY 0 0.00 0.00 0.00 2.00 0.50 0.50 0.00 3-00 $63.95 51,005.63 1183 I RIPEN-FT-ER , , $1.355.85 31,355.85 Training Adminl Dues Travel& savings other Other Total fnnges Sub Deduct- D 0 00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 I 530.80 50.00 $0.00 $0.00 $0.00 $10.80 $350-22 Other Deduction Notes:Training fee THIS ALL Federal FICA& State Vacation Health&I S 0.00 0.00 0.00 8.00 $.0-0 8.00 0.00 24.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension LOPEZ TORRES ALEJANDRO I PLUMBER $0.00 S110.53 561.30 $15.90 $0.00 $0.00 $0.00 0 I NotrriLITY 0 0.00 0.00 0.00 2.00 0.50 0.50 0.00 3.00 $69-20 ___, I_- tVl3 UTILITY PIPEF#TTER Adminl Travel& Total ' $1,257.07 11$4 F . , - $1,455.60 $1,455.60 Training Fringes Dues Sub Sav'ngs Other Deduct r 0 0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00 $9.00 $10.80 50.00 P.00 S0.00 SO.00 $10.80 $198.53 Direr Deduction Notes:Training fee E I THIS ALL Federal r FICA& Stale I Vacation Health& S 0.00 0.00 0-00 7.50 6.50 0,00 0.00 14.00 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension MQSQUEDA ARTURO PLUMBER/ $9.00 551.52 $11.51 $7.41 £0.00 SO.00 $0.00 UNDERGROU 0 #I D 0-4D 0.00 0_00 0A0 0.00 0.00 0.00 0.00 563.95 $420.37 1185 ND 11GR° PIPEFfTTER • Admin? Travel& Total• _ _ $679.00 $679.00 Training Fringes Dues Sub Savings Other Deduct. I D 0.00 0.00 4.00 0.00 0.00 0.00 0.00 0.00 $0.00 I r $5.60 $0.00 $0.00 50.00 50.00 5179.19 $258.63 Y Other Deduction Notes:Ira;riing fee and Garnishment I 1 I S 0A0 8.00 8.00 0.00 8.00 0.00 0.00 24M4) 348.50 PROJECT PROJECTS THIS r ALL FederalTa Medicare FICA& S alx sot Vacation Health& F _ Holiday Welfare Pension ges PLUMBER 1 - 5336.C-0 $176.38 $180.24 $25.35 50.00 $0.00 50.00 0 I UNDERGROU 0 0-00 1.50 0.00 0.00 2.00 0.00 0.00 3.50 $63-45' I ND UTILITY51,GG7.34 1186 PIPEF#TTER g li Dues Tr av l& Savings Other D ocital I _ S i.387.83 $2.323.70 Trainin I D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $u0.0t7 ! ub $11.09 $0.00 $0.00 $0.00 $0.00 $18-40 $718_36 Other Deduction Notes:Training fee S=STFLAIGlIT Tort 'OTHER-Any other deducriens,eontribulians andla enls whether or not i-Nrlud&1 or by prevailing w !om,1-1-131{Hew t Sp 0�OVERTIME may"' requited separately fisted- CERTIFICATION MUST be elect ng age determirhadnns m4rs[be } G=DDtFBLETIktE use extra eheetls}if necessary. (Sae reverse side) SDI=STATE DISABILITY INSURANCE