20220712150345628_Redacted09-21 Keller Water Storage Improvements Project 109-21 Keller Water Storage Improvements Project
U.S. Department of Labor PAYROLL
Wage and Hour Division (Far Contractor`s Optional Use; See Instructions at www.dol.govtwhdlformstwh347instr.htm)
Persons are no€ required to respond to Elie coflecdOn Of infpmtatlan unless it displays a currently valid OMB control number. Rev. Dec. 20084NNO
_ U.S. �l�s e a[f�C Iiuur 1)ii isuuD
NAME OF CONTRACTOR [] OR SUBCONTFACTOR Q 1:3059
ADDRESS: OMB NO_: 1235-DOO8
Creekside Electrical Contractors, Inc. Airport Rd., CarsonCity, W. 897W Expires: 7/31/2024
EPAYROLL NO. FOR WEEK NDING: IPROJECTANC LOCAT!CN: (PROJECT OR CONTRACT NO. II
46 612212022 JI09-21 Keller Water Storage lmprovernents Project, CA JI09.21 }Geller Water Storage Improvements Project
0) {2y €3] (4)DAY AND DATE ! {63 tW rn tat li l9l
RV. Thu I Fd I Sat I Sun I Mon I 'rue Wed DEDL MOMS
KAW uro VDIViDl1AL
rDEKT:FYING Hu"ER �� G py16 esn Ma M19 twrA OMM nfirz2 :NET WAGES
TOTAL PAID FOR
(e4.
e E L457 NUR E!R) O W 5001.4E 'iS WORK TOTAL RATE DF PAY GROSS AMOUNT FICA HOLDING STATE TA} LOCAL TAX
OTHER 01
SECURITY rr'l1iJP.ER]BFINORICB2 CLASSIFICATION - HOURS WORKED EACH DRY H01JR9 IARNW TAX TPX 1TDNS WEEK
h•.ITCHEI.L, LASH ELECTRIOIM ; KSIDE .... —_
_ WIREMAN S 0.00 O,DD 0.00 0.00 0,00 0.00 &00 8.D0 s59.s41 sD_06 $476.32
1 �O 0.00 0.00 0.00 0.00 D.OD 0,00 0.00 0,00 $0.001$0.00 36.45 14.OD 6A7 0.00 28.43 86.36 389,97
D D.00 0.00 0.00 0.00 0M 0.00 0.00 0100 $0.001$0.00 $476.32
While conpletion of Fonn WH-347 is optionarr R is mandatory for covered contraclors and subcomotws performing work on Federally financed Dr assisted construction contracts to respond to the information mileclien eonlained in 29 Cx_R_ §§ 3.3, 5.5(a]. The Copeland Act {ap
t1.SC. g 3145] contractors and subcontractors performing work on Federally financed or assrsted ocnstruc nn contras to "xnW, weekly a statement with respect to the wages paid each emptoyae during me preceding week." U-S_ Department of tabor {301-) regulat:ons at n C.F.R.
§ IJ raq� a ccn:ractaa tD sul;rrlit'-aekty a copy of all payrolls :o the F eder3i agency cc -.fading run z)r finarcing the cansJucliur project accompanied by a signed-Slatarnant of Compilancelnd ling that the payrolls are correct and compteie and that each laborer or
mechanic :has been pail n-t less mail the proper Davis actin preva:lin3 wage rate for the work perlonned- OL]L and federal contracting agencies receiving Ibis inforrrtatlen review the Hormatron to delermfne that employees have remived lagatly required wages and fringe benefits.
Public Burden Statement
We esGrnats that is will take an average of W minutes to complete this couectrDR, including tune for rev -wing Instructions, searching existing data so mxs gathering and manta ring the data maeded, and completing and rev owing the co section of it d6rmaGon. Ifyou have any
comments regarding these ess mates 4r any other aspect ur this collection, including suggesGDns for reducing this burden, send Them to the Administrator, Wage and Hour Division, US. Departrneni of Labor. Room S3502, 200 Constiiulion Avenue, N.W. Washington, O.C. 2021 a
[0�+1
Page 1 of 2
Date: 7/7/2022
Jennifer Andrews
(Name of Signatory Party)
do hereby state:
09-21 Keller Water Storage Improvements Project / 09-21 Keller Water Storage Improvements Project
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
President ®— Each laborer or mechanic listed in the above referenced payroll has been paid,
(Title) 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.
(1) That I pay or supervise the payment of the persons employed by
Creekside Electrical Contractors, Inc. on the (c) EXCEPTIONS
(Contractor or Subcontractor)
09-21 Keller Water Storage Improvements Project EXCEPTION (CRAFT)
(Building or Work) that during the payroll period commencing on the
16 day of June 2022 and ending the 22 day of June 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
Creekside Electrical Contractors, 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 C.F.R. Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,
63 Start. 108, 72 Stat, 967; 76 Stat. 357; 40 U.S.C. § 3145), and described below:
Permissible Deductions: 13.5% of Gross Wages to Vacation Fund, plus LMCC
(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
FX — 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.
REMARKS:
EXPLANATION
NAME AND TITLE SIGNATURE
Jennifer Andrews, President rl
THE WILLFUL FALSIFICATION OF ANY Ok THE ABOVE STATEMENTS MAY
SUBJECT THE CONTRACTOR OR SUBCO TR CTOR TO CIVIL OR CRIMINAL
PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31
OF THE UNITED STATES CODE.
Page 2 of 2
7/7/22, 2:21 PM
eCPR Form Applicatioh
eCPR Online Confirmation
Your payroll submission request: has been processed.
Please review the results of your submission. Should you have any questions please contact the eCPR unit at
publicworks@dir,ca.gov.
Contractor Name: CREEKSIDE ELECTRICAL CONTRACTORS, INC.
Contractor Address: 3059 AIRPORT RD. CARSON CITY NV 89706
Awarding Body: SOUTH TAHOE PUBLIC UTILITY DISTRICT
Project ID: 371032
Contract With: WHITE ROCK CONSTRUCTION, INC.
Week Ending Date: 2022-06-22
Payroll Number: 46
Amendment Number: 0
1 employee payroll record(s) processed
Your Transaction ID is: 14436969
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