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Date 10 8 2022
I, Katie McCroskv (Name of Signatory Party) S cr ("title)
do hereby state:
(1) That I pay or supervise the payment of the persons employed by
White Rock Construction Inc. (Contractor or Subcontractor) on the
Keller -Heavenly Phase 2 (Building or Work); that during the payroll period commencing on
10 2 2 22 and ending 10/8/2022 all persons employed on said project have been paid the full
weekly wages earned, that no rebates have been or will be made either directly or indirectly to or
on behalf of said
White Rock Construction Inc. (Contractor or Subcontractor)
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
as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. §
3145), and described below:
(2) That any payrolls otherwise under this contract 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 than the applicable wage rates contained in any wage determination incorporated into
the contract; that the classifications set forth therein for each laborer or mechanic conform with
the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor, or if no such recognized agency
exists in a State, are registered with the Bureau of Apprenticeship and Training, United States
Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
_ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in
the above referenced payroll, payments of fringe benefits as listed in the contract have
been or will be made to appropriate programs for the benefit of such employees, except
as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
'-RE
_ Each laborer or mechanic listed in the above referenced payroll has been paid, as
indicated on the payroll, an amount not less than the sum of the applicable basic hourly
wage rate plus the amount of the required fringe benefits as listed in the contract,
except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
REMARKS:
NAME AND TITLE
SIGNATURE
Katie McCrosky
Secretary
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECTTHE CONTRACTOR OR
SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
TITLE 31 OF THE UNITED STATES CODE.