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20230330104841495_RedactedSTATEMENT OF NON-PERFORMANCE Payroll Number: 10 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 10/23/2022 ending on the day of 10/29/2022 7�huthorize'd ` (Sig" of Person( 9) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dal.go►►/whdtformslwh347instr.htm) persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. NAME OF CONTRACTOR L OR SUBCONTRACTOR _ ADDRESS 769 Pinto Circle OMB No.: White Rock Construction Inc, Gardnerville NV 80410 Ex71m: PAYROLL NO FOR WEEK ENDING PROJECTAND LOCATION PROJECTOR CONTRACT NO. Keller-Heaventy Phase 2 1' 1115r2022 1100:00 AM 107:i 7,r. South Lake Tanoe CA %160 .: - NAME AND INDAADUAL IDEN7IF111JG . NUMBER (e.g., LAST FOUR DIGITS OF SOCIALSECURITY NUMBER) OF WORKER :s '_ NQ :DF - VYlH 7i(EMP TONS :::::::':; S:<' i>::'', '.., - : %; '' litlOR1C CLASSIFICATION OT OR ST 4 DAY AND DATE :;:;:::'. :1 ;::'' :> •; TOTAL HOURS :::::: ":, - . , . RATE OFPAY GROSS MOUNT EARNED PROJECT IPERIOD - ::>::. is DEDUCTIONS NE7 - VVAGES PAID FOR WEEK Stn on TAR Wed T� � - •- •' " FICA FEDERAL WITH- HOLDING TAX STATE WITH- HOLDING TAX MEDICARE OTHER.' ;.. ,. '. TOTAL DEDUCTIONS 30 31 1 2 3 4 6 •• HOURSVVO KEDEACH DAY German Franco 1 1000 GLP O 1 1.00 Z.00 3.00 80.17 2,179-24 135.11 457321 82.3C 31.L0 23.971 730.30 1,448.54 5 I I 1 0.001 8.001 8.QD1 7.001 31.001 62.54 _ 7-179,24 Alejandro C Martinez 1 1000 GLP C 1.001 2.001 100 1 80.17 2,085.43 129.30 226.01 137.15 30.24 22.94 546.27 1,539.16 S &00 8.00 5.00 5.50 29.50 61.0 T 2,065.43 Leslie McCroskv 0 1000 3 1.00 2.00 3.00 115.10 3,412.69 MEN_ D(3 S 5.00 7X0 9,00 8.00 7-00 35AI) 87.64 3,412.69 21159 527.21 212,84 49.49 37-54 1.038-66 2,374-03 - i Tolol5 for ProWa Kelleraieauenly Phase 2 5.0E 23.0E 27.0E 30.0E 19.50 1045 _ 7,5_77,3_5_ 7,67T.36 476.0E 1,210.57 432.&9 111.32 &4.45 2,315.23 5,362A3 White c�rr:cie4.^r rrForm WH-347Is nnt.cra:, it -s mnr: A,_-ry Fnrr-n:•ard contradors and subc,�Ora^'ors r Pwfcrnir3 wock on Federally financed or assiste^ ^rnstructim contracts to respond to the information collection contained In 29 C.F.R. %3.3, 5.5(a). The Copeland :act ;4C U.S.C. 5 3146) oontractors and suxcrtractors percrrr in; •.vark on Fedorailyf'r.anced or assisted construction contracts to "truism weekly a statement w :h respect to the wages paid each amp.cyee during the procadirg wee:<,•' U-S. Department of Labor(DOL) c0u.a nna :-1 2: C.- ' R, S 5.5[a}(3;{ii; require contractors to submit weekly a copy of all payrol Is to the Federal agency contracting far or financing the construction project, accompanied by a signed "Statement of Compliance' indicating that the payrolls are correct and complete and :-at eah laborer or neDhanic has been paid no. less than Ehe proper Davis -Bacon prevailing wage rate for the work performed DQL and federal contracting agencies receiving this information review the iriformatiori to determino that emplfyeeS haw recei+red iega y -c :u-.red wages and fringe ae e0[s. Public Burden Statement We estimate that is will take an average of SS minutes to complete this collection, including time for reviewing instructions, searching ebsting data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspect ofthis collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division. U.S. Department of Labor, Roam 5350 . 200 Constitution Avenue, N.W. Washington, D-C- 20210 Date 11 2022 I, Katie McCroskv (Name of Signatory Party) Secretary (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 10/30/2022 and ending 11/5/2022 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 ,-'�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 SUBJEC 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. STATEMENT OF NON-PERFORMANCE Payroll Number: 12 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 11/6/2022 ending on the day of 11/12/2022 (Si nature of the A d Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. i | ! | Ogg _ \ \ ( | "�|) �om ` , !§ \MO ( ! ( MO ; , .// . § §§ .\{ } QQ )r ; ;; •�§` °� ( � &i#@- . % ƒ d % m@` ! | ! ! /� \ , (go cy \ \ ( | \ \)« ] Date 11/19/2022 I, Katie McCroskv (Name of Signatory Party) Secre a (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 11/13/2022 and ending 11/19/2022 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 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 rCrosky Secretary THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECTTHE 7tHCTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. STATEMENT OF NON-PERFORMANCE Payroll Number: 14 Contractor: White Rock Construction Inc. Date: I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 11/20/2022 ending o the day of 11/26/2022 (Si nature of the uthorized Person) Katie McCrosky, ecretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. 3/30/2023 STATEMENT OF NON-PERFORMANCE Payroll Number: 15 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 11/27/2022 ending on the day of 12/3/2022 (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. } \ ' | /A | � mom III _ §) ,_ „ w '4m §Q ! m law , §§ woo �}\\\ &7% OU :()) � � \ "FZ \ , `;,MU ) \ Date 12/10/2022 I, Katie McCroskv (Name of Signatory Party) Secretary (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 12/4/2022 and ending 12/10/2022 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 _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 r Katie McCrosky Secretary THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT 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. : ! |WM ) \ | }0° §\ ] ;;; , f\ � � ! \!) ! - , . mm . ) ; x : „ „00 no gn�o ! [:) low ` ? 0 b§ / omco % [ ! ] ! ; /� ; ) , `«2 §!§ ! ) ( ;z ) ( !m`` Date 12/17/2022 I, Katie McCroskv (Name of Signatory Party) Secre (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 12/11/2022 and ending 12/17/2022 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 _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 SUBJ 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. STATEMENT OF NON-PERFORMANCE Payroll Number: 18 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 12/18/2022 ending o the day of 12/24/2022 S' nature of th A' uthorized Person Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 19 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 12/25/2022 ending on th day of 12/31/2022; (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 20 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 1/1/2023 ending on the day of 1/7/20231 r (Signature of th uthorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 21 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 1/8/2023 ending on the day of 1/14/2023 (Signature of the A orized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. Payroll Number: Contractor: STATEMENT OF NON-PERFORMANCE 22 White Rock Construction Inc. Date: I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 1/15/2023 ending o the day of 1/21/2023 ( gnature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. 3/30/2023 STATEMENT OF NON-PERFORMANCE Payroll Number: 23 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 1/22/2023 ending on !Pe day of 1/28/2023 ��� (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 24 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 1/29/2023 ending on the day of 2/4/2023,. i C.� (Signature of the AZhorizedPerson) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. Payroll Number: Contractor: STATEMENT OF NON-PERFORMANCE FW White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 2/5/2023 ending on the day of 2/11/2023 (Si/ �Aodzed Person Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 26 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 2/12/2023 Z ending on the day of 2/18f2023 ( ignature of he Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 27 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 2/19/2023 ending on thg day of 2/25/2023 (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 28 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 2/26/2023 ending on the day of 3/4/2023' r / Z (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 29 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 3/5/2023 ending on a day of 3/11/2023 (Signature of the Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 30 Date: 3/30/2023 Contractor: White Rock Construction Inc. I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 3/12/2023 ending on the day of 3/18/2023 ( Zignature of a Authorized Person) Katie McCrosky, Secretary (Name) This statement is not required to be submitted until after the submission of the initial payroll period. STATEMENT OF NON-PERFORMANCE Payroll Number: 31 Contractor: White Rock Construction Inc. Date: 3/30/2023 I do hereby state that no persons were employed on the construction of KH2 - Keller -Heavenly Phase 2 during the payroll period commencing on the day of 3/19/2023 =tuthorized 23 erson) (Name) This statement is not required to be submitted until after the submission of the initial payroll period.