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Certified Payroll Reports 18 to 33 Final Bowers Bijou_Redacted ail California Department o Indusof2022 Sowers 8 Sipou 213 Waterline Replacement Indust Relations i fOject f 20.30.8094 and 20,30.8281 PUBLIC WORKS PAYROLL REPORTING FORM [NAME OF CONTRACTOR:Vinciguerra Construction,Inc. Page 1 of$ [OR SUBCONTRACTOR: CONTRACTOR'S LICENSE NO.:358838 ADDRESS: P.D.Box 157,Sutter Creek.CA,95585 SPECIALTY LICENSE NO.: 'PAYROLL NO. FOR WEEK ENDING: SELF-INS11REDCERT; PROJECT OR CONTRACT NO.:20.30.8094 and 20.30.8281 [ 13 8120l2022 WORKERS'COMP: PROJECT AND LOCATION:2022 Bowers&Bijou 2/3 Waterline Replacement Project,ELD (1) I (2) I (3) -(4y DAY (5) (5) (7) 9 T W T F ts] (9) NA .ADDRESS 1 d f IE NET AND SO o [ WORK CIAL date SECURFIYNUM3ER y E CLASS TOTAL Y _ 1E GROSS AMOUNT WAGES 4F EFAPLOI' � IFICATICN 8/14 8f15 i 8115 8117 811$J 8/19 8120 HOuRs DF PAY EARNED , DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAIL} CHECK [ FOR NO Worked Each Day WEER Hoe Wo J S 0.00 8.00 6.00 8.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS THISALL F Tax!,Medicare FICA& Sax SDI tate vaealon Health e COWAN,THOM/S _ Holiday Welfare .Pension PLUMBER 1 ' 0 II I UNDERGRDU a 0.00 2.00- 0.50 1.00 1.50 2.00 0.00 7.00^$68.20 $497.00 $242.83 $198.11 $29.13 $O.pU $0.00 30.00 NO UTILITY [ PIPEFITTER Adrnin i Travel E - $1,721.93 1201 i $2,564.40 52,668.20 Traning Dues Savings Oth Total f Fringes Sub Other Deduct. D 0-00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $18.80 $0.t30 SO.00 $0-00 $0.00 S19.40 $946.27 I Other Deduction Notes:Tj ]jf1g„tgg 1THIS ALL FICA& [ S 0.00 6.50 8.40 5.00 8-04 O.00 0.00 30,50 548.50 PROJECT 'PROJECTS Federal Tax Medicare Tax SDIVacation Health& CRAIG,CHRIS J Holiday Welfare Pension PLUIr1BERf r 0 J UNDEROROU $226_00, $126.81 $96.72 $18.24 $0.00 $0,00 $0.00 J ND UTLLIT 0 0.00 0.0E 0.50 1.00 1.50 0.00 0 00 3.00 •$53.95 J PIPEFITTER - $1.671.10 51,671.10 Training' Admin� p Travel& $1.1t#9-93 1252 Fnnges U� Sub Savings Other Total 1 D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 _ deduct. 513-40 $0,(30 $0.00' $0.00 $0.00 S13.40 $481.17 I Jlli f �- Other Deduction Notes:Training fee THIS ALL [ S 0.00 0.00 0.00 8.00 9,04 8.00 0.00 24.00 $90.64 PROJECT PROJECTS FeTdaeral FICA&e S7 la tx Sl]! Vacation Health&Hpfiday welfare Pension DAVIOS4N_B[304E I Operating J EngineerJ 0 (Heavy 8 0 0.00 0.00 0.00 1.OQ i 0 2.00 0.00 4.50 $113.G $0.00 $209.59 $0.00 $30.15 $0.00 $0.00 $0.00 .High Area 0 -S2.501.04 1253 [Group Area 1 ' $2,713.Sfi $2,773.3E TrainingA.drnirl I Dues & Total Fdr ges uss sub Savings Other a 0.00 0.00 ODD 0.00 0.00 O.D0 0.00 O.00 S0.00 tOeduct. I - 331.s2 30-00 56.00 50.00 50.00 532.48 5272.32 Other Deduction Notes:Training fee &0=STR TWEE 'aT}t£R-Any ocher dedbrceiers,contributions and/or Form A-Z_13I(MAN 2-90) o= iouBLETi payrnerrts whether or tql incrrded or required d1•prevaiKrxJ'�'ege 4trtemunalions must be separately lislCd. CERTIFICATION U. be can OVERTIMEO Use ectra sheens)il neeeaw , scar�STATE DISABILITY NSURANCF (Sea re e se sde) ae*Pd AR. California Department of 2022 Bowers&Bijou;3 Waterline Replacement Project J 20.30.8094 and 20,303281 Induslrial Relations PUBLIC WORKS PAYROLL REPORTING FORM (1). (2) I (3) {4}DAY ' (5) {sy 7 Page 2 of a NAME,ADDRSS 'z I l t.1 1 T ! W I T I F I 5 AND SGCFAI. o a o WORK 1 Date NET etASS- HOCRr GROSS AMOUNT WAGES SECURITY EMPLOYEE ER 2xx # IFICAT�N 8 14 g115 $J16 8117 8l18 $d19 St20 TOTAL DFPTAEY DE[]UCTIONS,CQNi(ZISUTIDNS FWp PAYtvlf=hFTS PAFO CHECK OFEMAL6YEE EARNED NO. 31. f FOR Hours ri'orked Each Day WEEK f S 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $$48.50 PROJECT PROJECTS Tax Federal Medicare FICA& State SDI g Health e Holiday Wetfate Pension DEARMON,MCt I PLUMBER! ` - 4 UNDERGROU $109.00 8137.25 5107.97 $19.74 50.00 50.00 SU.00 J N❑UTILITY O 0.00 0.00 0.00 0.00 1.75 2A0 0.00 3.75 $63.95 P1PEFITTER Admin 1 Fravel&_ $1,Di5.81 $1,802.19 Training dues Total 51,d24.33 1254 Fringe$ Sun Savings Other DeduC!. D 0-00 0.00 0.00 O.Ot) 0-00 0.00 0.00 4.00 $0.00 } $7.90 50.00 50.00 50.00 50.00 57.90 5381.86' Other Deduction Notes:Training fee THIS ALL I S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $48.50 PROJECT PR ECTSS F de Taxr3l MedicFICAare S Taxe Natation Wel e Sal Ha6day JVelfare Pension GRIEGO.f3 I PLUMBER I Y ii 0 I UTIGI;OU $413.00 $188.51 $179.22 $27.11 $0.00 $0.00 50.00 I NO UTILITY 0 0.00 1.50 1.00 1.50 1.50 2.00 0.00 7.50 $63.85 �� _ I PIPEFITTER _ _ Admin/ Travel8 - $1,05$ 1255 ( 1 32.d19.S3 $2483.58 Training Frnges Dues Sub Savings Other Total Deduct. [ I D 0.00 0.00 0.00 4.00 0.00 0.60 0.00 0-40 5[1.00 $19-00 $0.0l $0.00 $0.00 $0.00 $19.40 $827,24 - Other Deduction Notes:Training fee THIS ALL , I S 0.00 8.00 $.OD $_GD 8.00 S_f70 0.00 38.00 $45.50 PROJECT PROJECTS TFeddaeral FICAare Stale Shc Vacation Helth LOSQUEDA. Tax Holiday Welfare Si Pension ART PLUMBER J 0 UNDERGROU 5253.00 5149.56 5124.40 $21.50 50.00 $0.00 $0.00 I ND UTILITY 0 0.00 0,50 0.50 0_50 0.50 0.00 0.00 2.00 563.95 I P1FEFITTER r _ Adminl Travel8 -,31,232.86 1256 r $1,9T0.90 31,370.9p Training Fringes Dues Savings rather Total I 9 Sub Deduct. D 0.0D 0 00 0.00 0.00 0.00 0.00 D.00 C_00 solo S16.00 $0.00 $0.00 50.0D $0.00 5189,59 $735.05 Other Deduction Notes:7ra;rrina fee pod Garnisha]mpj I _Y-- - - THIS I 5 0.00 0.06 D t a.on 0.00 0.08 0.00 8.00 s ss-sa PROJECT 'r=RtALL Federal MFedicare Tax 8. rStale sun Tax HVacation Health 8o liday Welfare Pension TO,AARON PLUMBER! - OA _ 0 I UNDERGROU 5104.00 $98.03 555.51 514.10 SO Mtn 50.00 1 ND uTILITY 0 0.00 0.00 0.00 1.00 0.00 0,00 0.00 1.00 $63.95 PIPEFFTTER Admin! Travel& - $1•009.86 1257 5451.95• $1.291.90 Training Fringes t]ues Sub Savings Other Total { Deduct_ D 0.00 4.D0 0.00 0.00 0.00 0.00 O.OR 0.00 $O-00 I 53,60 508100 50.00 50.00 S4.00 $10.40 $282.04 - _l _ - Other Deduction Notes- Irainiat as S=STRAIvHT TIME 'OTHER-Any oilier dedierrs,cdMrih.:lions and/or Form A-1-131(Now 210) S'O R71Ms ixt peyn ants whether or not inciu ar required by prevsAing rage dyterTy ons must be se ❑= VERTI E Use extra streetts)it rice y. parn!ery k5ted. CERTIF1CATtDN I Z ba CoiTF3e]ed SDI=STATE DISABIUTY MNSt/RANCE {SBa reyg side) Califor a R De partrne ❑apartment Industrial Re la 2022 Bowers S Bijou 2I3 Waterline Replacement Project 120.30.t3p94 and 24.30.82$1 Relations PUBLIC WORKS PAYROLL REPORTING FORM f 1y {2y (3) Page a of 6 { (4)DAY (5) (8) (7) (8) S I M 1 T I W I T I F I S ' (gf 2 _ AND SOCIA. o$e V10RK NET NAME.AEORE$5 SECURITY NUMBER o$ CL 15S- Date TOTAL YHOUR_ GROSS AMOUNT WAGES CHECKpF EMPLOYEEz IFiCAT!Qp 8I1d 8115 rage $117 8rt& $/1$ g�p0 HOURS PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID t FOR NO. Hours Worked Each Day WEEK -_,,___1_ THIS ALL Federal FICA& State Vacation Health 8 r S 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Pension ONETO, Ho Welfare CHRISTDP - 0 UNDERGROU PLUMBER R $132.00 S121.05 $83.56. $17.41 $0.00 $0.00 50 00 NO UTILITY 0 0.00 2.00 1.50 1.50 0.00 Q_Qb 0.00 5.00 $69.20 PIPEFITTER T $1.594.00 $1,594.QQ Training Adrnins Dues Travel& Total 5f,148.68 1258 Fges Sub Savings other t3educl. 0 0.00 0.00 0.00 0.00 0.40 0.00 0.00 0.00 S0.00 - - 511.60 $0.00 S0.00 S0.00 $0.00 $91.30 $445.32. Other Deduction Notes:Traini09 fee and G I S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 548.50 PROJECT PROJECTS THIS ALL ETax ] Medicare FICA& State vacation Health FASTEN SDI Holiday Welfare Pension VELASQUFI, PLUMBER1 - - - _ 29 ELISIO 0 I UNpER $ 8.00 $176.36 $157.51 $25.36 $0.00 $0.00 $0.00 ND UTILITY 0 0.00 1.00 0.00 0.50 1_50 2.00 0.00 5.00 $63.95 r $1,648.07 1258 PIFEFITTER _ $2,259.75 AdrrtinJ Travel&$2,328.70 Training Dues Savin s Other Total Fridges Sub 9 Deduct_ 0 0.00 0.00 0.00 C.00 0.00 0.00 0.00 0.00 $0.00 $18.00 S0.00 $0.00 S0.00 $0.00 $16.40 $675.63 ,..�,_ Other Deduction Notes:Training THIS ALL S 0.00 8.00 0.00 8.00 8.00 8.00 0.00 32.00 $52.00 PROJECT PROJECTS Federal Tax Medicare FICA& Saxe Holiday Wetfa e SDt Holiday Wetfafe Pension IPEREZ,SEI0 PLUMBER I - - LINOERGR 1S378.00 S171.05 5753.15 524.59 $0.00 50.00 S0.00 ND TILITY 0 0.60 2.00 0.00 2.00 1.50 2_00 0.00 7.50 $69.20 PIPEFITTER - - $2,183.00 $2,252.20 Training Fdrnins Savings Deduct Dues Travel Other Total $7.509'21 1260 �41e Sub 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.80 $0.00 $0.00 $0.00 $0.00 $16.20 $742.99 r r Other Deduction Notes:Talio fee r ]I r S 0.00 8.00 e.onj 8.00 8.00 8.00 o-0a 32.00 $ae.tio PROJECT PRTHIS OJECTS L lax I M�tare. Stale FICA& Tax so, Varzlan Heattt�$ JSAB ,MORGAfJ t t Ivkday Welfare pension PLUMBER/ ' 0 UNDERGROU 54Z8.00 5t93-37 8185.72 527,80 fi0.00 $O.00' $OAO ND UTILITY 0 0.00 0.000-50 1.00 2A0 2.00 0.00 5.50 563.95 PiP£FITTER Tnfa1 $1,692.Sd t261 -� J $1,903.73 $2,517.53 Training Fringes Dues TrSuh& 9 Other Savin s 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 _ DeducF. r _ $15.+70 $0_00 $0.00 $0.00^ 5(3.00 $19.80 8854.65 Other Deduction Notes: fr 0in r 8 STRAIGHT TIME HER-pry a{het ded coons•conlrrir'te a arcten Pay Farm A-1-131(New 1.$0) O==DUcRTIhiE OTmerHs whether or mot irwyad¢d a,require9 by pnwaiing cadge��°+rrwrafions Haas!be separately ksFad. CEF2TIFICATfOP3 MUST be Corn ❑=40UBLETk 1E use ewesfwrHs)if necessary. l SOl=STATE❑ISAeruTY INSURANCE (See reverse side] California 46111111 Department of 2022 Bowers&Bijou 2►3 Waterline Replacement P Industrial RelationsProject/2Q•30.8094 and 20.30.8281 PUBLIC WORKS PAYROLL REPORTING FORM (1' (2) 1 (3) (4)DAY (5) (s) Page 4 OF 8 M T W T F S NAME,ADORES 3v AND SOCIA t i 6 i r5 WORK Date rr4Ul NET SECURITY UUF 13ER ?_ ION 8rid 8f4$I811$18►i7I 8ft$ 8179 8120 OF PAY TOTAL GF2OE+4RN BUNT WAGES CF EMPLOYEE IF CAT HOOKS CLASS- .1 r RATE DEDUCTIONS,CONTR{BUFIONS AND PAYMENTS PAID CHECKFOR NO. I Hours Worked Eath pay WEFic r 5 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS FederalTHIS ALL T FICAB State Vacation Neelth$ STANFILL, Medicare Tax SDl Ffokday Welfare Pension PLUMBER► y 0 11NDERGROl1 $514.00 $207.90 $205.15 $29.$9 $0.00 $0.00 $0.00 ND UTILITY d 0.00 200 1.00 2.00 1.50 2.00 0-p0 $.ra0 $fi9.20 PlpEFffTER Admirt► Traveld S1,7G0.66 1262 J $2.6ti8.20 $2-737.40' Training FM ques savings Other Total { Suh Ded D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.04 $19.40 S0.00 $0.60 $0.00 $0.00 S19.80 $976.74 Older Deduction Notes:Training fee 1 MIS ALL S 0.00 0.00 0.00 8.00 S_00 8.00 0.00 24.00 $52.00 PROJECT PROJECTS FeTax Medicare Tax 501 HolidFICA& State ay He alth e TAYLOR. Holiday VYeHare P 1Ofi KRISTOPHER PLUMBER 1 -- - 1 UNDERGROL! $1135.00 $142.10 $111.71 $20,43 $0.00 $0.00 $0_oQ ND UTILITY 0 Q 0.00 0.00 2.00' 2.00200 0.00 6.00 $69,20 _ PIPEFITTERActin� ► - $1,418.36 1263 avel $1,653.20 $1,870.130 Training Fringes Dues T Subs Savings, Other Total Deduct O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $12.00 $0.00 $0.00 $0-00 $0.00 513.20 $452.44 1 f Other Deduction Notes:Training fee I S 0.00 0.00 8.00 8.00 8.00 8.00 0.00 32.00 $85.64 PROJECT PROJECTS THIS ALL Federal Medicare FICA Tatx Vacation�Welfareelh e VINC[GUERRASDI Pension AUSTIN Operating _ • - - A _ * _ Holiday - - Engineer - $741.00 S343.54 $381.07 $49.40 $0.00 $0.00 $0.00 2 { {Heavy& 0 0.00 0.00 1.00 2.00 2.00 2.00 0.00 7.00 $112.1 Highway work)/ 0 •$2,975.59 1264 1 Group 3 Area 1 - $3,525.1$ $4.546.50 Training Ad min i Dues Travel 8 Savings Other Total I s Sub g Deduct. D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 -' - $43.68 $0.00 $0.00 $0.00 $0.00 $56.00 $1,571.01 I- f Other-Deduction Notes:Jrainlnq j 1 i I S O.OrI 6.tT0 8.06 8.00 8.06 8-ew 9.Od 4p.Qp SI35 g.� PRpkrSGT PROJECTS THIS ALL Federal FICA& State Vacation Health S LNCIOU , Medicare Tax SDI Fiords} Welfare Pension CASEY Operating 63 S282 Engineer $447.00 $258. .08 $37.19 $0.00 {Heavy& 0 0.0e Opp 0.00 0.00 etc aye 0.00 0.00 5112.1 4 $fl.OQ 50.00 lig hway work]10 $2 204.82 1265 Group 3 Area 1 - -- $3,425.60 $3,425�0 Training Adam i alas sub Savings Other Deduct Travel S Total Fringes I D 0.00 0.00 0.00 0.00 GAO 0.00 0.00 0-00 $0.00 r 1 i $44.60 S0.00 $0.00' $0.00 $0.00 $216.08 $1,220.9 t 8 Other Deduction Notes:Trainmo fee and CalSavers contribution S =STRR TIM E '',ZITHER-Any other 4aducliMs,ooMntwlions ar>dlar TIGHT 11I payments one iher of noi nciu orryuireet by prevarrrng wage detemwnarans m st re separately ksted. CERTIFICATION MUST be nampleled Form A-1-131{flew 2$0) 0=OVER G 0=DOUBLE- ,tE Me extra sh SDI=STATE DISAsiu Y rNSUR AtdCE (See remorse sided dill California Department of 2022 Bowers&Bijou 2/3 Waterline Replacement Project 120.303094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORMA (1 (2) I (3) Page of I (4)DAY {5) (0 (7) (8) (9) NAME.AI7f}RE35 3 v0 I s 1 M I T r W I T f F 1 5 _ AND SCCIA! `�° WORK L- NET SECURITY VUII+�ER z � I CLASS- Dale FETAL v GROSS AMOUNT OuRL WAGES CHECK OF E41PtCFYI . ! IFICATION 8r14 /8115 8118 1 8117 16/18 18119 I 8r70 ' - OF PAY EARNED DEDUCT[ONS,CONTRIBUTIONS AND PAYMENTS PAID FOR NO. Hours`Nc tceC Each Day WEEK 1 FI 1 T~ THIS. ALL S 0.00 0.G0 8.00 $.00 7.00 8.00 0.00 31.00 S49.50 PROJECT PROJECTS Federal Tax Medic FICAare Slate Vacation health e 5QI Holiday WeNare Pension i.WRIGH7,G DLL I I I PLUMBER ! - �J LINDERGROU $388.00 $167.81 $148.82 $24.13 $0.00 $0.00 S0.00 i ND UTILITY 0 0-00 0.00 0.00 0.50 0.00 2.00 0.00 2.50 $63.95 PIpOFITTER - S1.663.38 52,211.25 Trainingmini Traval& Total $1,d84.$9 1269 Fnnges DIES Sub Savings Other Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 0-00 C.00 50.00 ' S13.40 50.00 $0.00 $0_00 $0.00 $17.50 $726.36 1 I c , Other Deduction Notes:Traie ry fPP f r TFIIS I S 0.00 8.00 8.00 6.00 8.00 8.00 0.00 40.00 S90.64 PROJECT PROJECTS ALL F Tax al Medicare Tax FICA& e Holiday I Welfare & SDI HgGda Welfare �grPslan YOUNG MN I Operating _ _ Y I Engineer $784.00 $350.98 S393.75 S50.47 $0.00 $0.00 $0.00 f {Heavy 8 0 OM 1.00 1.50 1.00 1.50 2.00 0.00 7.00 $1'E$. + 0 Highway work)! ACmin 1 Travel 8 $2,776.57 1270 I Group 3 Area 1 Sub $4 A62.80 $4,642.20,Training Fria es Dues Sayings Other Data l I ` 9 Deduct. 0 0.00 0.00 0.00 0,60 0.00 0.00 0.00 0.00 $0.00 $52.64 $0.00 $0.00 S0.00 $0_D0 $286-43 $1.885.6 .4- I 3 f Other Deduction Notes:Training In-,and Ca!Savers COntnfNUM S=STRAIG#;T TIME 'OTHER-Any other deduKionn,mr rii!ul�ons and.'« Form A-1-131 New 2 60) 0=DOOUBLE- payrnarrs wteeflher a real included or regtired by rxeva}5nq wage delerrrinaliortg mus!tie segaralely Wed. CERTIFICATION h�4iJ57 be d=DOUBLE-ME Use extra sheets)if necesSary. completed SOP:STATE DISAaILlFV tNSURA.NOF (See reverse side) I 4 R California Department of 2022 Bowers&Bijou 2!3 Waterline Replacement Project 120.30.8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM STATE OF CALIFORNIA Page$of STATEMENT OF COMPLIANCE CONTRACTOR I SUBCONTRACTOR CONTRACT NUMBER Vinciguerra Constructicn,Inc. FIRST DAY AND DATE OF PAY PERIOD20,30.8094 and 210.36.8281 • EAST DAY AND DATE OF PAY PERIOD 8f 412022 8/20/2022 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 Mirfull 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 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 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) Ei Determined by the Director of Industrial Relations for the county or counties in which the work is performed;that the classification set forth therein far 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 fringes benefits as listed in the contract: (a) c Have been or will be paid to the approved plants),funds(s),or prograrn(s)for the benefit of listed employee(s),except as noted below. (b) 2 Have been paid directly to the listed employee(s),except as noted below. (cj E See exceptions noted below. EXCEPTION CRAFT EXPLANATION 1. . REMARKS:Except for Training Funds for all Crafts paid directly to CAC. INAME(PLEASE 3RINT.) Austin Vinciguerra TITLE President 1SIG SIGNATURE: DATE i 8/25/2022 '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 any of the above statements may subject the contractor or subcontrac',or to civil or criminal prosecution(See section 1001 of title 18 and section 3729 of fide 31 of the United States Code). ADA Notice Foy individuals with sensory disabilities,this docement is available in alternate formats.for information calr(916)651 8410 or TDD(916)65.4-3880 or write Records and Forms OEM 250i Management, 1120 N Street, MS-89, Sacramento, CA 95814. d l California Department of 2022 Bowers&Bi}cu 213 Waterline Replacement F}rojec112D-34,13094 and 20.30.$2$1 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORMA Page 1af� I NAME OF CONTRACTOR:Vinciguerra Construction,Inc. CONTRACTORS LICENSE NO.:358838 ADDRESS:P.O.Box 157,Sutter Creek,CA,$5685 JCR SUBCONTRACTOR: SPECIALTY LICENSE NO,: I PAYROLL NO. FOR WEEK ENDING: SELF--INSURER CERT: PROJECT OR CONTRACT NO.:20.30.0094 and 20.30.8281 I 19 $127R022 WORKERS'COMP: PROJECT AND LOCATION:2022 Bowers&Bijou 2/3 Waterline Replacement Project,ELD (I) (2) II (3) (41 DAY ` (5) (6) (7) (8) (9) I S L.I T ' W l T F S ° - NAME,ADDRESS o I wol�lc NET AND SOCIAL J`a E CLPyS.� Date TOTAL HOURLY GROSS AMOUNT WAGES CHECK RATE SECURITY NUMBER w I. IFICATION 8121 8122 8123 81241 8125 8/26 18Y27 L+DUKs OF PAY EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID FORor NO. Hours Worked Each DayWEEK THIS ALL Federal FICA_& State SOl Vacation Health& Penso in I S 0.00 0.00 8.00 6.00 8.00 8-00 0.00 32.00 $52.00 PROJECT PROJECTS Tax Medicare_ Tax Hoiday Welfare LEVALOJDSA PLUMBER! `$210.00 S178.95 S/55.52 $25.73 $0.00 $0.00 50,00+ I UNDERGROU 4 I ND UTILITY0 0.00 0.00 2.00 2-00 2.90 1.50 0.00 7.50 $69.20 ^- - - $1.761.00 1292 PIPEFITTER Admin J Travel 8 $2,t83.00 $2,356-00 Training Frirges DVeS Sub Savings Other De e t C duct. E 0 0.00 0-00 0.00 0.00 0.00 0-00 0.00 0-00 50.00 ( 51$.80 $0.00 90.00 $0.00 $0.06 $16.80 $595.00. Other Deduction Notes:T in t'o tee Prt THIS ALL Federal FICA& State TVacation Health& I S 0.00 8.00 8.00 8.04 9.00 6.00 0.00 40-00 $52.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Weitare Pension - WAN.THOMAS I PLUMBER) I UNDERGROU $472-40 $194.73 $187.55 $28.00 $0.00 $0.00 $0.00 0 I ND UTILITY 0 0.00 0.50 0.50 1.00 1.50 2.00 0.00 5_50 $69.20 51,663.32 1273 1 PIPEFITTER _ _ $2,460_60 $2.564.40 Training F�nges Dues T ha Savings Other oToodtaudl k. 0 0.00 0,04 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $18.20 $9_00 S0.00 $0.00 $0.00 $18.80 $901.08 I Other Deduction Notes: iri i I THIS ALL Federal FICA 8 State Vacation Health& I S 0.00 6.50 8.00 8.00 am8.00 0.00 38.50 $48.50 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension CRAIG,CiiRl$ I PLUMBER 1 $342.00Y 5165.98 $149.09 523,86, $0-00' $0.00 $0.00 0 I ND UTILITY 0 0.00 0.00 1.00 0.50 2-00 1.00 0.00 4.50 $63.95 I NE]UTEIJTY - $1,488-67 1274 PIPEFFrTER Admin J Travel& Total 1 $2,155.03 $2,107.00 Training Fringes Dues Sub Saving8 Other Deduct. I 6 0.00 0.80 000 0.00 Q.00 0.00 o.00 o.00 so.uo. gi7.28 30-00 30.06 >0.00 50-00 $77.40 5638.33 Other Deduction Notes:Training fee 5 II STRAtGH F TIME 'OTHER-My a4rer deductions.rrwdr tone for payments wherhpr 04 rral nckided or required by prevae w e deierrrer�5ens moo be❑e ciouBL ME �6 a9 sepsr�ni/fisted. CERTfF1CATION) l be completes Form A-1-t$l(New 2-$s) Use extra stsat(s,it neasssery. (See re a se side) t]_❑OVBLETiLIE SDI--STATF DISASIUTv INS J9ANGE I - - - dinCalifornia Department of 2022 Bowers&Bgou 2 OWWaterhine Replacement Project!20.30.8094 and 20.30.8281 industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM P4ge20fa (1) (2) I (3) (4)DAY (5) (6} (7) (8) (9) I SIMFI W T F $ I.&AME,ADDRESS s g I NET a_ WORK WAGES CHECK AND SOCIAL 0;; CLASS- - dale TOTAL HOURLY GROSS AMOUNT DE0UC1IONS,CONTRIBUTIONS AND PAYMENTS PAID SECURITY NUMBER off' RATE OF EMPLO' E x:x IFHCATION 8121 8221 l 8124 18125 8/26 8(27 HouRs OF PAY EARNEO NO. FOR IHours Worked Each Day WEEK THIS ALL Federal FICA& Slate Vacation Health 8 I S 0.00 6.00 8.00 8.00 8.00 7.00 0.00 37.00 548.50 PROJECT PROJECTS Tax Medicare Tax SD Holiday welfare Pension I _ PLUMBER, -" - # UNDERGROU 5280.00 $145.87 $12220 $20.97 $0.00 50.00 $0.00 0 0 0.00 0.00 0.50 0.00 1.50 0-00 0.00 2.00 $63.95 NO UTILITYA -I Total $1,337.76 1277 } PIPEFITTER . $1,922.40 $1,922.40 Training n ges Dues Traub vel& Savings Other Deduct, I D 0.00 0 00 0.00 0.00 0.00 0.00 0.00 0.00 50.00 S 15 60 S0.00 $0.00 $0.00 $0.00 $15.60 $.5/54.64 Other Deduction Notes:Iraini00.1ot i THIS • ALL Federal I FICA& State Vacation Heetth8 I S 0.00 0-00 0.00 0.00 0.00 7.50 0.00 7.50 $48.50 PROJECT 'PROJECTS Tax Medicare Tax SDI Hnay Wye Pension ONETO,AaRON 1 PLUMBER! - UNDERGROU 1 $273.00 $156.26 5133.36 S22.47 50.00 $0.00 $0.00 0 0 0.00 0.00 0.00 0.00 0.00 0.00 olio 0.00 $63.95 ,51,457.41 1278 NO UTILITY Total I PIPEFITTER 5363.75 $2,059.10 Training Fringes Dues Travel Sub Sayings ether Deduct. I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 I 53.00 $0.00 S0.00 $0.00 $0.00 $16.60 S601.69 Other Deduction Notes:Training lee I . THIS ALL Federat FICA& State SDI Vacation Health& pension I S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $52.00 PROJECT PROJECTS Tax Medicare Tax Hotlday Welfare ON ETO, I C HRISTOPHEF PLUMBER 1 1 5345.00 $210.53 $203.21 $30,27 $0.00 50.00 $0.00 0 I UNDERGROU 0 0.00 1.60 0.50 2.00 2.00 2.00 0.00 8.00 $69.20 I ND UTILITY r $1,824.38 279 PIPEFITTER , , 52,633.E+0 $2,772.80 Training Admiral Dui Travel8 Savings Other Toted Fringes Sub Deduct. tI 0 4.00 0.00 0.00 0.00 0.00 0.00 0.00' 0.00 50.00 $1920 50.00 $0.00 $0.00 $0.00 $158,60 5947.81 - Other Deduction Notes:Ireinine fee arid CalSavers aril/tutor; THIS ALL Federal FICA& State Vacation Health& I S 0.00 0.00 0,W 0.00 0,0p 0.p0 0.00 6.00 548.50 PROJECT PROJECTS Tex Medicare Tax 3aJl 1-loliday Welfare Pension PASTER VELASQUEZ, PLUMBER! S224.00 $152.64 5125.80 $21.95 $0.00 S0.00 $0.00 E LE310 0 ND UTILITY UNDERGROU O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 563.95 1 N PIPEFITTER Adm. Travel& w Todad ngs £7,370.31 12$U I 5388.U0 $2,011.65 Training Fringes Sub savings i Oesar deduct_ I 0 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 30.00[ I - t $320 50.00 50.00 5004 50.00 S116.98 $641.37 Other Deduction Notes:Training fee agd CalSavers contrihulio0 _ 0 S STRAIGHT TIME 'OTHER-Any other ded n udios.conssos ne ardor Yea'merits whether rx notind sled a requ ae by preys j wag e ge detern�lne8ens must be separately fisted. CERTIFICATION M1351 be eempteted Form A--s-1.11(gm 2-80) -� RLaT Use cairn sMN{S}Ili necessary. 4See reverse el ❑_O VERTI TIME $0I=STATE OISAa IGT!INSURANCE dill California Department of 2022 Bowers&Bijou 2/3 Waterline Replaeement Project/20.30.8094 and 20.30.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of 5 [1} ( ) I (3) {4)DAY (5) (5` I/) I8) (9) S tt I T I W I T NAME,ADDRESS V2 I AND SOCIAL o-iE WORK Date _ TOTAL HOURLY GROSS AMO RATEUNT WAGES SEGURITYNUMBER � IFICA$T N 8/21 1 8/24�81Y5 8f26 8127 �URs OF PAY EARNED C3EDL1CTIdtJS.CQNTR{BUTIQNSANDPAYhiEM1f75 FOR CHECK NO . OF EMPLOYEE "W 1 I Hours Worked Each Day WEEK I THIS 1 ALL Federal FICA& State Vacation Health& I S 0.00 0-00 8,00 8,00• 8.00 0.00 0.00 24.00 552.00 PROJECT PROJECTS Tax Medicare Tax SDI Hogday Welfare Perreon PEREZ,SERGIO PLUMBER) 5273.00 $136.85 $107.40 $18.68 50.00 $0.00 $0.00 1 { NOUNDERGROUUTILITY 0 0.00 0.00 0.00 0.00 1-00 0.00 0.00 1-00 $59.20 ND UTILITY 51,251.87 tat I PIPEFITTER $1,31720. $1,862.40 Training Fig Dues T sup Savings Other t7e�ucll 0 0.00 0.00 0-40 0.00 e.00 0.00 0.00 000 50.00 51{).00 $0.00 $4-00' $0.00 $0.00 $13_80 $550.53 I • Other Deduction NOles,Trainirrn leg THIS ALL Federal FICA& State SDI Vacation Health& I S 0.00 0.00 0.00 0.00 0.00 3.00 0.00 3.00 $a8.50 PROJECT PROJECTS Tax Medicare Tax Nokiay Welfare Peas n SABEa 1A I PLUMBER/ ` ' -- �, I • UNDERGROU r 5399.00 $184.01 $17320 526.48 $0.00 S0.00 $0.00 0 ( 0 0.00 0.00 0.00 0-00 0.00 1.00 0.00 1.00 583.95 - 51,622.61 1282 NO UTILTY I PIPEFE TER 5209.45 $2.424.38 Training Frt 1 Dues Travel& Sari Othe r Total Fr rages Sub n Deduct. I 0 0.00 0.00 0-00 0.00 0.00 0.00 0.00 0.00 50 00 I 51.60 $0.00 50.00 Salk $0.00 $19.10 S801.77 Other Deduction Noses-Training fee THIS ALL Federal FICA& Slate Vacation Health& S. 0.00 8.00 8.00 8.001, 8.00 8.00 0.90 40.00 552.00 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension 1STANFILL, 1 PLUMBER LUMBER CHRISTOPHE UNDERGROU 5431.00 $101.58 5169,96 526.11 $0.00 $0.00 $0.00 0 ND UTILITY 0 0.04 0.50 1.00 0,00 1.50 1_50 0.00 4.50 569.20 - 51,564.95 1283 PIPEFITTER � - $2.391.40 52,391.40 Training del rain/ Dues Travel& Savings Other Total Fringes Sub Deduct- t D 0.09 0.00 0.00 0.00 0.00 0.00 0-00 OW 50.00 $17.80 $0.00 $0_00 $0-00 50.00 $17.80 $826.45 L l Other Deduction Notes:Trainin9jge I THIS ALL Federal FICA& Slate Vacation Health& 1 f C 0 00 o-00 e.00 e_oo o.o0 0.00 o.ee 10,00 352.00 PIIOJ ECT PROJECTS' Tax Medicare Tex Sal Holiday Welfare P,srrsrvn TAYLOR, ` KRISTOPtiER I PLUMBER 1 " - 5406-00 $231.58 $231.36 $33.30 $0.00 $0.00 $0.00 1 I UN DERGROU O 0.000.00 2.00 2.00 0.00 0.00 0.00 4.00 489.20 - -$,2,124.46 1284 I ND UTILITY PIPEFITTER Admin 1 Travel& 9 Total I 5/.108.80 $3,048.ao Training Fringes Dues Sub Savings Other I D 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 50.00 Iwoo Sam SR.00 $0.00 $0.00 $21.W 5923.84 Other Deduction Niles:Training8g &-STRAIGHT TINE 'OTHER-My other deductions.x Ih Dens andr r payments Abether or not Irolrnded a red byseparately Isted. CERTIRCAT1odd{MI be completed 0-OVERTYdE Use extra s if Preraikng wage deiCrmirratiaxs must be Roan A-1--1 31 041We 2-40j p_DeueLETImE �+ ( J wry- {See revgr5e side} SD/=STATE DlSA3IL ITY 1M1FSLI RArNCE an California Department of 2022 8 3wers&Bijou 213 Waterline Replacement Project?20.30.8094 and 24.30.82$4 Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 Of 5 (.I (2) I f3) 0)DAY (5) (5) (7) (8) r (9) S AlT W T F IS 1 NAME,A3ORESS og WORK NET ANDS]CIAL ape I CLASS- date Tara NR RATE GROSS AMOUNT WAGES SECURITYNUNk3ER ox RATE EARNED DEDUCTIONS,CONTRIBUTIONS AND PAYMENTS PAID CHECK OF EMPLOYEE _ IFICATION $f21 8I22 8123 18(24'$f25 8126 8'27 HOURS OF PAY FOR NO. Hat:*Worked Each Day WEEK THIS ALL Federal FICA& . Stale Vacation Heath 8 S 0.00 0.00 0.00 4,50 0.00 8.00 0.00 12.50 $85.64 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension VINC1GllE3RA, I Operating .--e- _ :MS TIN Engineer $714A0 $335.04 $369.72 548.17 50-00 $0.00 $O-00 2 1 (Heavy& 0 0.00 0.06 0.00 2.00 9.00 0.50 0.00 2.50 $112.10 52,912.69 I 1285 Highway work)i Aamin 1 Travel$. Total I Group 3 Area 1 - $5,350.75 $4,434-50 Training Fringes Dues Sub Savings Other „ 0 0.00 0.00 0.00 0.00 0.00 0-00 0.00 0-00 50_00 515.80 50.00, 50.00 50.00 $0_00 554.88 51,521.8 1 Other Deduction Notes Training tee • I - TH1S ALL Federal FICA& State SDI Vacation Health S Pension S (LOU 8.00 8.00' 8.CO 8.00 8.00 0.00 40-DO $85-64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare CI VINGUERA., - _ ❑peretl CASEY ErxJineer -- r $447.90 $258.63 $262.08 $37.19 $6.00 $0.00 $0.00 4 (Heavy& 0 0.00 0.00 0-00 0.00 0.60 0.00 0.00 0.00 $112.10 52,204.62 1286 Highway work)I Admin! Travel Total I Group 3 Area 1 ' - 33,425.fi0 53,425.60 Training Fringes Dues Sub Savings Other DeduCf. I 0 0.00: 0.00 (LOU; 0.00 0.00 000 0.00 0.00 50.00 $44-80 g0-00 $o-oa 50.00 $0.00 $21$,08I 51,220.9 8 `` Other Deductior Notes:Traiing feen and CalSav_ers cantrib'rlign r I THIS ALL Federal FICA& State Va a54n Health& I S 0.00 0.00 0.00 0.00 0.00 3.50 0.00 3.50 $48-50 PROJECT PROJECTS Tax Medicare Tar 501 Holiday Welfare Pension WRIGHT COLLIN 1 PLUMBER I ' LJNE3ERGRQU $266.00 S134.61 S104.40 $19.35 $Q.00 $0.00 $0.00 4 MOO O 0.00 0.00 0.00 (LOU0.50 0.00 0.50 $53-95 - - .$1.235.10 1290 ND UTIL[TY 1 PIPEFITTER _ _ - r - $201.73 $1,773.71 Training FriAd rzres n i {Ions Travel Sayings Other Total g _ Deduct. I 0 0-00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 g1.60 50-00 50-00 S0-00 $0.00 $14.25 $538 61 I Other Deduction Notes:Training fee THIS ALL Federal FICA& State Vao an Health&S O-DO e-oq 8.00 8.00 8.90 8.00 0.00 ao.00 $yp,6q pRp,tEGT Pfta.fEGiS Tax Medicare Tax Sat Ftakday Welfare Pereio- y I I Operating _ , F Engineer $656,00 $310,18 $339.21 $44.54 50.00 $0-00 $0.00 ll 1 (Heavy 5 0 0.00 0.50 1.00 0.00 1.50 1.00 0.00 4.00 $119.50 $2,499.53 1291 'Highway work)! Admin 1 Trowel& Tatel I Group 3 Area 1 - - _ $4,104-00 $4,104-DO Training Fringes 17ues Sub Savings Ocher Deduct- ) D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (LOU 50.00 $i.G04.4 I $4928 $0-00 $0.00 $0.40 $n-00 $254-48 7 Other Deduclion Notes'Training fee and CalSavers contribution S=STRAIGHT TWEE 'OTHER-Arty 0Oserdeeiraipns,centrirsuliers andior payments whether or net inducted or required by Prevair rag determinations muse be s 0=OVERTIME Use extra sheelisl if necessary_ vre a �a��s&d. G£RT lFICAee reverse be oo d fare R-1-131(New 2-a8) p=DOUBLE ITME (See reverse side) SDI R STATE 0ISA(JLITY!N3JRAN E 461111511 California Department of 2022 Bowers Bijou 2J3 Waterline Replacement Protect 124.30.869d and 2t7.3Q.8281 Industrial Relations PUBLIC WORKS PAYROLL REPORTING 1FORNI Page of STATE CF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOR SUBCONTRACTOR CONTRACT NUMBER Vinciguerra Construction,Inc. 20,30.848d and 20.30.8281 FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD 812112022 8127f2022 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 their full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor from the full weekly wages earned by any person and that no decuctions 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 aech 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) [J Specified in the applicable wage determination incorporated into the contract; (b) J 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 fringes benefits as listed in the contract: (a) 1=-1 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) [ Have been paid directly to the listed employee(s),except as noted below. (c) ❑ See exceptions noted below. EXCEPTION CRAFT EXPLANATION REMARK$.Except for Training Funds for all Crafts paid directly to CAC. NAME(PLEASE PRINT.) TITLE Austin Vinciguerra President l SIGNATURE: DATE 9M 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 falsificatice of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution(See section 1001 of titre 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 inronra atlon call(916)651 6410 or TOD(916)654-3&9O or write Records and Forms Ct_M 2593 Management,1120 N Street,MS-39,Sacramento, CA 95814.