Certified Payroll Records 6 thru 9_RedactedCalifornia
JWR
Department of
Herbert
Walkup Pipeline Replacement t Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 1 of 3
I NAME OF CONTRACTOR: Vinciguerra Construction, Inc.
CONTRACTOR'S LICENSE NO.: 358838
ADDRESS:
P. O. Box 157, Sutter Creek, CA, 95685 j
OR SUBCONTRACTOR:
SPECIALTY LICENSE NO.:
I PAYROLL NO.
I FOR WEEK ENDING:
-INSURED CERT:
PROJECT OR CONTRACT NO.: Herbert
Walkup
Pipeline
JI
6
5/18/2024
(SELF
WORKERS' COMP:
PROJECT AND LOCATION:
I
Herbert Walkup Pipeline
Replacement, ELD
(1)
(2) 1 (3)
1
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I M I T I W I T I F
I S
NAME,ADDRESS
AND SOCIAL
?z I
❑o WORK
o o E 1 CLASS
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES CHECK
SECURITY NUMBER
d = 2
Z IFICATION
5/12 15/13 15/14 15115 15/16 15117) 5/18
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
3
FOR
Hours Worked Each Day
WEEK
I
S
0.00 0.00 4.00 0.00 8.00 8.00
0.00
20.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
AREVALO, JOSHUA
155 Hillside Place
' PLUMBER /
UNDERGROU
$160.00
$150.42
$119.79
$21.63
$0.00
$0.00 $0.00
5642
4 ND UTILITY O
0.00 0.00 1.00 0.00 1.00 1.00
0.00
3.00
$68.79
$1,395.85 D/D
PIPEFITTER
�
$1,249.17 $1,975.42 Training
Admin /
Dues
Travel &
Savings
Other Total
Fringes
Sub
Deduct.
-
U
U:uu u.UU u:Uu U:OU U:UU 0.00
0:00
_ 0:00
_ $0.00
$9.20
$0.00
$0.00
$0.00
$0.00
_.
$127.731
$579.57
Other Deduction Notes: Trainino fee and Cal,Savers contribution
I
S
0.00 7.00 8.00 8.00 8.00 6.50
0.00
37.50
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
GIRARDIN, FLOYD
I PLUMBER /
$330.00
$169.36
$142.07
$24.35
$0.00
$0.00 $0.00
P. 0. Box 102 River
5
UNDERGROU
1 ND UTILITY O
0.00 0.00 2.00 0.00 1.50 0.00
0.00
3.50
$68.79
$1,548.03 D/D
PIPEFITTER
$2,196.02 $2,230.41 Training
Admin /
Dues
Travel &
Savings
Other Total
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
$16.40
$0.00
$0.00
$0.00
$0.00
$16.60 $682.38
Other Deduction Notes: Training fee
S
0.00 7.50 8.00 8.00 8.00 5.00
0.00
36.50
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
MERCIER,
'
BRANDON
400 Cragmont Court
PLUMBER/
UNDERGROU
$264.00
$149.71
$115.79
$21.52
$0.00
$0.00 $0.00
Cameron Park CA
1 ND UTILITY O
0.00 0.00 0.50 0.50 0.00 0.00
0.0
0
1.00
$68.79
$1,405.88 D/D
95 2
PIPEFITTER
�
$1,971.90 $1,971.90 Training
Admin /
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
S15.00
$0.00
$0.00
$0.00
$0.00
$15.00 $566.02
Other Deduction Notes: Training fee
S = STRAIGHT TIME OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side Form A-1-131 New 2-80) ( )
( D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
JEN
Department
of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 2 of 3
(1)
(2)
1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9'
S I
M I
T
I W I
T I
F
I S
NAME,ADDRESS
AND SOCIAL
oNI
�-ao
o � �
WORK
�
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITYNUMBER
0 o a
z3
CLASS-
IFICATION
5/12 15/13
15/14'
5/15 1
5116 1
5/17
15/18
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
EMPLOYEE O EE
i
FOR
Hours Worked Each Day
WEEK
I
S
0.00
7.50
7.50
8.00
8.00
6.50
0.00
37.50
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health & Pension
Welfare
REYNOSO, LUIS
8399 Steelhead
pLUMBER /
UNDERGROU
$270.00
$14SA3
$117.13
$21.34
$0.00
$0.00 $0.00
Avenue Kings Beach
0
ND UTILITY
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$68.79
$1,383.35 D/D
PIPEFITTER
$1,955.25
$1,955.25 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
I
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$15.00
$0.00
$0.00
$0.00
$0.00
$15.00 $571.90
Other Deduction Notes: Trainina fee
_.
S
6.00
7.50
7.50
7.50
8.00
7.50
0.00
38.00
$52.14
TWt
PROJECT
7oelbrai-FlC-A-Ae=__-
PROJECTS Tax Medicare Tax
SDI
-vacation--Health
Pension
Holiday Welfare
SABIA, MORGAN
1413 Rancho Way
pLUMBER /
UNDERGROU
$298.00
$158.26
$130.27
$22.76
$0.00
$0.00 $0.00
South Lake Tahoe
0
� ND UTILITY
O
0.00
0.00
0.00
0.00
1.50
0.00
0.00
1.50
$68.79
$1,459.42 D/D
NNE
PIPEFITTER
�
$2,084.51
$2,084.51 Training
Admin /
Dues
Travel &
Savings
Other Total
Fringes
Sub
Deduct.
�
D
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
$15.80 $625.09
Other Deduction Notes: Training fee
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
$95.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
VINCIGUERRA,
Operating
Engineer
� 9 En
$535.00
$288.96
$298.96
$41.55
$0.00
$0.00 $0.00
330 BodTIN
30 odega Court El
Dorado Hills CA
2
(Heavy &
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0
$127.0
$2,612.73 D/D
Highway work) /
Group 3 Area 1
$3,825.60
$3,825.60 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$48.40
$0.00
$0.00
$0,00
$0.00
$48.40 $1,212.8
Other Deduction Notes: Training fee
S
0.00
0.00
0.00
0,00
8,00
0.00
0.00
8.00
$95.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
VINCIGUERRA,
Operating
CASEY
Engineer
$508.00
$291.92
$296.83
$41.98
$0.00
$0.00 $0.00
470 Broadmeadows
Court Sutter Creek
4
(Heavy &
O
0.00
0.00
0.00
0.00
0.00
0.0o
0.00
0.00
$127.0
0
$2,447.65 DID
Highway work) /
Group 3 Area 1
$765.12
$3,825.60 Training
Admin 1
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$9.66
$0.00
$0.00
$0.00
$0.00
377 ,. $19
$239.22 5
Other Deduction Notes: Training fee
S = STRAIGHT TIME "OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. (See reverse side)
Form A-1-131 (New 2-80) D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
Department of
Industrial Relations
TATE OF CALIFORNIA
TATEMENT OF COMPLIANCE
ONTRACTOR/SUBCONTRACTOR
Vinciguerra Construction, Inc.
PST DAY AND DATE OF PAY PERIOD
5/12/2024
10 hereby certify under penalty of perjury:
Herbert Walkup Pipeline Replacement / Herbert Walkup Pipeline
PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of 3
CONTRACT NUMBER
Herbert Walkup Pipeline
LAST DAY AND DATE OF PAY PERIOD
5/18/2024
(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
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) M 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) 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) El See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
EMARKS: Except for Training funds for all crafts paid directly to CAC.
AME (PLEASE PRINT.) TITLE
ustin Vinciguerra President
IGNATURE:I G / DATE
6/10/2024
n 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
Isification 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 title 31 of the United States Code).
DA Notice For 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 CEM 2503
Management, 1120 N Street, MS-89, Sacramento, CA 95814.
California
Department of
Herbert
Walkup Pipeline Replacement /Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 1 of 6
1 NAME OF CONTRACTOR: Vinciguerra Construction, Inc.
CONTRACTOR'S LICENSE NO.: 358838
ADDRESS: P. O. Box 157, Sutter Creek, CA, 95685'
FOR SUBCONTRACTOR:
SPECIALTY LICENSE NO.:
7 O.
PAYROLLPROJECT
I FOR WEEK ENDING:
I
OR CONTRACT NO.: Herbert Walkup
Pipe
(ine
5/25/2024
WORKERS' COMP:
IPROJECT AND LOCATION:
Herbert Walkup Pipeline
Replacement, ELD
(1)
(2) 1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I M I T I W( T I F
5
NAME,ADDRESS
?zI
0o WORK
Date
NET
AND SOCIAL
SECURITY NUMBER
o o a
d x - CLASS-
Z Y w IFICATION
5/19 5/20
I I
TOTAL
HOURS
HOUTL
Y RATE
GROSS AMOUNT
EARNED
DEDUCTIONS, CONTRIBUTIONS
WAGES
AND PAYMENTS PAID CHECK
OF EMPLOYEE
�w
5/21 5122 5/23 5/24
I I I I
5/25
OF PAY
NO.
FOR
3
Hours Worked Each Day
WEEK
S
0.00 0.00 4.00 4.00 4.00 4.00
0.00
16.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
AREVALO, JOSHUA
155 Hillside Place
PLUMBER /
UNDERGROU
$412.00
$252.55
$256.37
$36.31
$0.00 $0.00 $0.00
4 ND UTILITY O
0.00 0.00 2.00 1.50 2.00 2.00
0.00
7.50
$68.79
$2,144.27 D/D
�642
PIPEFITTER
$1,350.17 $3,331.13 Training
Admin /
Dues
Travel &
SavingTotal
s Other
Fringes
Sub
Deduct.
(
00G.00
-
-- - --- -- - --
$9.40
--
$0.00
$0.00
$0.00
- -
$1,186.8
$0.00 $229.63 6
Other Deduction Notes: Trainino fee and CalSavers contribution
1
S
0.00 0.00 4.00 4.00 4.00 4.00
0.00
16.00
$90.64
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
AREVALO, JOSHUA
155 Hillside Place
Operating
Engineer
$412.00
$252.55
$256.37
$36.31
$0.00 $0.00 $0.00
642Highway
4 (Heavy & O
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$119.5
0
$2,144.27 D/D
�
work) /
Group 3 Area 1
$1,450.24 $3,331.13 Training
Admin /
Dues
Travel &
Total
Savings Other
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
$19.36
$0.00
$0.00
$0.00
$1,186.8
$0.00 $229.63 6
Other Deduction Notes: Trainino fee and CalSavers contrihution
1
S
0.00 0.00 8.00 8.00 8.00 8.00
0.00
32.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
CORREA,ERICK
PLUMBER/
1535 Hussman
UNDERGROU
$19.00
$160.20
$53.85
$21.60
$0.00 $0.00 $0.00
Avenue Gardnerville
0 O
ND UTILITY
0.00 0.00 1.50 1.00 2.00 0.00
0.00
4.50
$68.79
$1,718.79 2129
NV 89410
PIPEFITTER
$1,978.04 $1,978.04 Training
Admin !
Dues
Travel &
Total
Savings Other
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
$14.60
$0.00
$0.00
$0.00
$0.00 $14.60 $259.25
Other Deduction Notes: Training fee
S = STRAIGHT TIME 'OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheets if necessa
Form A-1-131 (New 2-80) D = DOUBLETIME () ry' (See reverse side)
SDI = STATE DISABILITY INSURANCE
California
am
21
Department
of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial
Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 2 of 6
(1)
(2) 1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M
I T
I W I
T
I F
I S
NAME,ADDRESS
AND SOCIAL
LLoo WORK
o ,_
Date
HOURL
GROSS AMOUNT
NET
WAGES
SECURITY NUMBER
CLASS -TOTAL_
Z� W I (CATION
5/19 I
5/20 5/21
I
5/22
I I
5/23 5124 5125
I I
HOURS
of RATE
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID CHECK NO.
OF EMPLOYEE
3
FOR
Hours Worked Each
Day
WEEK
I
S
0.00
0.00
4.00
4.00
4.00
4.00
0.00
16.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
l
Vacation Heath & Holiday Welfare Pension
COWAN, THOMAS
12650 C
PLUMBER/
UNDERGROU
$471.00
$201.57
$188.19
$28.98
$0.00 $0.00 $0.00
Shenandoah Road
0 ND UTILITY
O
0.00
0.00
2.00
1.50
2.00
0.00
0.00
5.50
$68.79
$1,407.29 D/D
95669
PIPEFITTER
�
$1,212.59 $2,662.83 Training
Admin /
Dues
Travel &
Savings Other Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$8.60
$0.00
$0.00
$0.00
$1,255.5
$0.00 $365.80 4
Other Deduction Notes: Trainino fee and Garnishment
71 IFS-----94L=L- -Federal-PtG'A-8r
U6.c
SDI
4aCattan- 9eatiii -
Pension
S
0.00
0.00
4.00
4.00
4.00
4.00
0.00
16.00
$90.64
PROJECT PROJECTS Tax
Medicare
Tax
Holiday Welfare
COWAN, THOMAS
Operating
12650 C
Engineer
$471.00
$201.57
$188.19
$28.98
$0.00 $0.00 $0.00
Shenandoah Road
0 (Heavy &
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
O.OD
$119.5
$1,407.29 D/D
669
Highway work) !
� Group 3 Area 1
$1,450.24 $2,662.83 Training
Admin /
Dues
Travel &
Total
Savings Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$19.36
$0.00
$0.00
$0.00
$0.00 $365.80 $1,255.5
4
Other Deduction Notes: Training Fee and Garnishment
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
GARIBALDI,
ANTHONY
PLUMBER /
$375.00
$171.13
$147.49
$24.61
$0.00 $0.00 $0.00
P. O. Box 985 Sutter
UNDERGROU
0 ND UTILITY
O
0.00
0.00
2.00
2.00
2.00
0.50
0.00
6.50
$68.79
$1,518.77 D/D
85
PIPEFITTER
$2,115.62 $2,253.20 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings Other Total
Deduct,
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$15.40
$0.00
$0.00
$0.00
$0.00 $16.20 $734.43
Other Deduction Notes: Training fee
S
0.00
8.00
8.00
8.00
8.00
8,00
0.00
40.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
GIRARDIN, FLOYD
I PLUMBER /
$435.00
$202.79
$186.79
$29.16
$0.00 $0.00 $0,00
P. 0. Box 102 River
UNDERGROU
1 ND UTILITY
O
0.00
0.50
2.00
2.00
2.00
0.50
0.00
7.00
$68.79
$1,797.18 D/D
PIPEFITTER
$2,567.13 $2,670.32 Training
Admin /
Dues
Travel &
Savings Other Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$18.80
$0.00
$0.00
$0.00
$0.00 $19.40 $873.14
Other Deduction Notes: Trainino Fee
S = STRAIGHT TIME 'OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side Form A-1-131 New 2-80) ( )
( D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
JMN
Department of
Herbert
Walkup Pipeline Replacement
/ Herbert Walkup Pipeline
Industrial
Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 3 of 6
(1)
(2) 1
(3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M
I T
I W I
T I
F
I S
NAME, ADDRESS
?z I
moo
WORK
Date
NET
AND SOCIAL
SECURITY NUMBER
o �
Z? w
CLASS -TOTAL
5l19 I
I
I
HOURS
HouRL
F P
GROSS AMOUNT
EARNED
DEDUCTIONS, CONTRIBUTIONS
WAGES
AND PAYMENTS PAID CHECK
NO.
OF EMPLOYEE
3
I ICAT N
5/20
5/21
5122 I
5/23 I
5124
I 5/25
OAY
FOR
Hours Worked Each
Day
WEEK
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
pension
GRIEGO, DAVID
1730 Rock Springs
pLUMBER /
UNDERGROU
$378.00
$184.71
$165,64
$26.56
$0.00
$0.00
$0.00
Road Escondido CA
0
ND UTILITY
O
0.00
0,00
2.00
1.50
2.00
0.50
0.00
6.00
$68.79
$1,659.50 D/D
PIPEFITTER
$2,081.22
$2,430.01 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other
Total
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.0o
0.00
$0.00
$15.20
$0.00
$0.00
$0.00
$0.00
$15.60
$770.51
Other Deduction Notes: Training Fee
7� IIS---AL-L
-Federate
=ReA-&-- a
SDI
pension
vacation-Healthh&
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
LIMAS, ABRAHAM
PLUMBER/
1535 Hussman
$36.00
$152.82
$50.80
$21,97
$0.00
$0.00
$0.00
Avenue Gardnerville
0
UNDERGROU
NO UTILITY
O
0.00
0.00
2.00
1.00
2.00
0.00
0.00
5.00
$68.79
$1,736.04 2130
PIPEFITTER
$2,012.43
$2,012.43 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other
Total
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$14.80
$0.00
$0.00
$0.00
$0.00
$14.80
$276.39
Other Deduction Notes: Training fee
S
0.00
8.00
8.00
8.00
8.00
7.00
0.00
39.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
MERCIER,
I
BRANDON
PLUMBER/
$413.00
$198.83
$181.49
$28.59
$0.00
$0.00
$0.00
400 Cragmont Court
1
UNDERGROU
O
0.00
1,50
2.00
2.00
Cameron Park CA
ND UTILITY
2.00
0.00
0.00
7.50
$68.79
$1,777.27 D/D
95682
'
PIPEFITTER
$2,549.39
$2,618.18 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
I
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
�
$18.60
$0.00
$0.00
$0.00
$0.00
$19.00
$840.91
Other
Deduction Notes: Training fee
(
S
0.00
0.00
0.00
8.00
8.00
8,00
0.00
24.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
PEREZ, SERGIO
I
PLUMBER /
$195.00
$116.05
$69.18
$16.69
$0.00
$0.00
$0.00
149 Oak Ridge Drive
1
UNDERGROU
ND UTILITY
O
0.00
0.00
0.00
1.50
2.00
0.50
0.00
4.00
$68.79
$1,118.40 D/D
00
PIPEFITTER
$1,526.52
$1,526.52 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$11.20
$0.00
$0.00
$0.00
$0.00
$11.20
$408.12
Other Deduction Notes: Training fee
S = STRAIGHT TIME 'OTHER- Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheot(s) it necessary. See reverse side Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
401California
Department of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 4 of 6
(1)
(2)
1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
�u
o o
o o a
1
WORK
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
o
c x
IFICAT N
5/19 15/20
15/21
15/22 15/23
15/24
15/25
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AID
AND PAYMENTS FOR
NO.
OF EMPLOYEE
t W
I
Hours Worked Each Day
WEEK
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health & Pension
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
REYNOSO, LUIS
8399 Steelhead
PLUMBER /
$378.00
$184.49
$165.35
$26,53
$0.00
$0.00 $0.00
AvenueUNDERGROU Beach
0
ND UTILITY
O
0.00
0.00
2.00
1.00
2.00
0.00
0.00
5.00
$68.79
$1,657.18 D/D
PIPEFITTER
�
$2,429.55
$2,429.55 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
�
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$18.00
$0.00
$0.00
$0.00
$0.00
$18.00 $772.37
Other Deduction Notes: Training fee
T'L116-
ALL
I"13AA
Ella«
SDI
Vacation-H-66.6, -^
Pension
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
SABIA,MORGAN
1413 Rancho Way
PLUMBER/
$378.00
$184.48
$165.35
$26.52
$0.00
$0.00 $0.00
South Lake Tahoe
0
UNDERGROU
ND UTILITY
O
0.00
0.00
2.00
1.00
2.00
0.00
0.00
5.00
$68.79
$1,657.20 D/D
CA 96150
PIPEFITTER
$2,429.55
$2,429.55 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
�
�
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$18.00
$0.00
$0.00
$0.00
$0.00
$18.00 $772.35
Other Deduction Notes: Training fee
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health &
Pension
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
$95.64
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
VINCIGUERRA,
Operating
TIN
Engineer
$735.00
$356.32
$389.04
$51.23
$0.00
$0.00 $0.00
330 Bodega Court El
od
Dorado
Dorado Hills CA
2
work)
O
0.00
0.00
2.00
2.00
2.00
0.50
0.00
6.50
$127.0
0
$3,126.14 D/D
Highway /
Group 3 Area 1
$4,651.10
$4,714.60 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Total
Other Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$56.27
$0.00
$0.00
$0.00
$0.00
$1,588.4
$56.87 6
Other Deduction Notes: Training fee
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health &
Pension
S
0.00
8.00
0.00
8.00
8.00
8.00
0.00
32.00
$95.64
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
VINCIGUERRA,
Operating
CASEY
Engineer
$556.00
$308.94
$319.59
$44.42
$0.00
$0.00 $0.00
470 Broadmeadows
Court Sutter Creek
4
Heavy&
O
0.00
0.00
0.00
1.00
1.00
0.00
0.00
2.00
$127.0
0
$2,664.73 D/D
CACA 95�
Highway work) /
Group 3 Area 1
$3,314.48
$4,079.60 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Total
Other Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$41.14
$0.00
$0.00
$0.00
$0.00
514 ,. $18
$285.92 7
Other Deduction
Notes: Trainino fee and CalSavers contributuion
S = STRAIGHT TIME 'OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra shoot(s) if necessary. (See reverse side)
Form A-1-131 (New 2-80) D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
am
Department of
Herbert
Walkup Pipeline eline Replacement /Herbert Walkup P Pi eline
P
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 5 of E
(1)
(2) 1
(3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I M I T I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
?z I
'0 512,
o
WORK
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
X
CLASS-
IFICATION
5/19 15120 15/21 15/22 1
5/23 1
5/24 15/25
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS
PAID NO.
OF EMPLOYEE
'' w
3
FOR
Hours Worked Each Day
WEEK
I
THIS ALL Federal
FICA &
State
SDI
Vacation Health &
Pension
S
0.00 8.00 8.00 8.00
8.00
8.00
0.00
40.00
$95.64
PROJECT PROJECTS Tax
Medicare
Tax
Holiday Welfare
YOUNG, JIM
Operating
Engineer
$710.00
$341.88
$372.78
$49.16
$0.00 $0.00
$0.00
P. O. Box 58
Fidd etown A 95629
1
O
0.00 0.00 2.00 1.50
2.00
0.00
0.00
5.50
$127 0
0
$2,723,77 D/D
Highway work) /
Group 3 Area 1
$4,524.10 $4,524.10 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings Other
Total
Deduct.
D
0.00 0.00 0.00 0.00
0.00
0.00
0.00
0.00
$0.00
$55.06
$0.00
$0.00
$0.00
$0.00 $326.51
$1,800.3
Other Deduction Notes: Trainina fee and CalSavers contribution
_. Ti III ALL 7.:,v,&[
,SIG
-del -
SDI
VU aS ,- Il�ellhd
Pension
S
0.00 8.00 8.00 8.00
8.00
8.00
0.00
40.00
$52.14
PROJECT PROJECTS Tax
Medicare
Tax
Holiday Welfare
ZELLERS,JEREMY
8194 MAIN ST
1
PLUMBER/
$350.00
$200.18
$180.24
$28.78
$0.00 $0.00
$0.00
MOKELUMNE HILL
0
I
UNDERGROU ND UTILITY
O
0.00 0.50 2.00 2.00
2.00
0.00
0.00
6.50
$68.79
$1,716.52 D/D
CA 95�
�
PIPEFITTER
$2,532.74 $2,635.92 Training
Admin /
Dues
Travel &
Savings Other
Total
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00
0.00
0.00
0.00
0.00
$0.00
$18.60
$0.00
$0.00
$0.00
$0.00 $160.20
$919.40
Other Deduction Notes: Trainino fee and Garnishment
S = STRAIGHT TIME OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
JON
California
Department of
Industrial Relations
FATE OF CALIFORNIA
rATEMENT OF COMPLIANCE
DNTRACTOR/SUBCONTRACTOR
Vinciguerra Construction, Inc.
RST DAY AND DATE OF PAY PERIOD
5/19/2024
to hereby certify under penalty of perjury:
Herbert Walkup Pipeline Replacement / Herbert Walkup Pipeline
PUBLIC WORKS PAYROLL REPORTING FORM Page 6of6
CONTRACT NUMBER
Herbert Walkup Pipeline
LAST DAY AND DATE OF PAY PERIOD
5/25/2024
(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
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) ED 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) 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
MARKS: Except for Training funds for all crafts paid directly to CAC.
4ME (PLEASE PRINT.) TITLE
istin Vinciguerra --- President
GNATURE:I G �� DATE
6/10/2024
i 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
Isification 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 title 31 of the United States Code).
)A Notice For 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 CEM 2503
Management, 1120 N Street, MS-89, Sacramento, CA 95814.
JORCalifornia
Department of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page of
1 NAME OF CONTRACTOR: Vinciguerra Construction, Inc.
CONTRACTOR'S LICENSE NO.: 358838
ADDRESS: P. O. Box 157, Sutter Creek, CA, 95s85j
[OR SUBCONTRACTOR:
SPECIALTY LICENSE NO.:
(PAYROLL NO.
( FOR WEEK ENDING:
ISELF-INSURED CERT:
OR CONTRACT NO.: Herbert Walkup Pipeline
{I
8
6/1/2024
(WORKERS' COMP:
(PROJECT
PROJECT AND LOCATION:
Herbert
Walkup Pipeline
Replacement, ELD
(1)
(2) 1 (3)
I
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I M I T I W I
T I F
I S
NAME,ADDRESS
AND SOCIAL
?z1
0o WORK
ooa I
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
CLASS-
°z i w IFICATION
5/26 5/27 5128 5/29
I I I I
5/30 5/31
I
I 6/01
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
3W
FOR
Hours Worked Each Day
WEEK
I
S
0.00 0.00 4.00 4.00
4.00 4.00
0.00
16.00
$90.64
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
AREVALO, JOSHUA
Operating
Engineer
$463.00
$270.15
$279.90
$38.84
$0.00 $0.00 $0.00
155 Hillside Place
642
4 (Heavy & O
0.00 0.00 0.00 0.00
0.00 0.00
0.00
0.00
$119 5
p
$2,265.60 D!D
Highway work) /
Group 3 Area 1
$1,450.24 $3,564.31 Training
Admin /
Fringes
Dues
Travel &
Savings Other Total
Sub
Deduct.
t0---
0.00 -0.00 0.00 0.00
0.00 0.00
0.00
0.00
$0.00
$19.36
$O.00
$0.001
_
$0.00I
- $1 298 7
$0.00 $246.82 1
Other Deduction Notes: TRAINING. CAL SAVERS
1
S
0.00 0.00 4.00 4.00
4.00 4.00
0.00
16.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
AREVALO, JOSHUA
I PLUMBER /
$463.00
$270.15
$279.90
$38.84
$0.00 $0.00 $0.00
155 Hillside Place
5642
UNDERGROU
4 ND UTILITY O
0.00 0.00 2.00 2.00
2.00 2.00
0.00
8.00
$68.79
$2,265.60 D/D
PIPEFITTER
$1,384.56 $3,564.31 Training
Admin!
Dues
Travel&
Savings Other Total
Fringes
Sub
Deduct.
D
0.00 0.00 0.00 0.00
0.00 0.00
0.00
0.00
$0.00
$9.60
$0.00
$0.00
$0.00
$1,298.7
$0.00 $246.82 1
Other Deduction Notes: TRAINING. CAL SAVERS
1
S
0.00 0.00 8.00 8.00
8.00 8.00
0.00
32.00
$52.14
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
CORREA, ERICK
1535 Hussman
pLUMBER /
$72.00
$168.52
$77.88
$24.23
$0.00 $0.00 $0.00
Avenue Gardnerville
UNDERGROU
0 ND UTILITY O
0.00 0.00 2.00 2.00
1.50 2.00
0.00
7.50
$68.79
$1,860.17 2335
PIPEFITTER
�
$2,184.41 $2,218.80 Training
Admin/
Dues
Travel&
Savings Other Total
Fringes
Sub
Deduct.
� D
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 $16.00 $358.63
Other Deduction Notes: Trainina
S = STRAIGHT TIME *OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
California
Department
of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 2 of 7
(1)
(2)
1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S
I M I
T
I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
? z
LLoo
o �
1
WORK
I
Date
GROSS AMOUNT
NET
WAGES CHECK
SECURITY NUMBER
°z = w
CLASS -TOTAL
IFICAT N
5/26 15/27 1
5/28
15129 1
5/30 15/31 16/01
OURS
RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS FOR NO.
OF EMPLOYEE
3x
w
Hours Worked Each
Day
WEEK
I
S
0.00
0.00
4.00
4.00
4.00
4.00
0.00
16.00
$90.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
COWAN, THOMAS
Operating
12650 C
Engineer
$553.00
$227.72
$223.17
$32.75
$0.00 $0.00 $0.00
Shenandoah Road
0
' (Heavy &
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$119.50
$1,602.34 D/D
95669
Highway work) /
Group 3 Area 1
$1,450.24
$3,006.78 Training
Admin /
Dues
Travel &
Savings Other Total
Fringes
Sub
Deduct.
'
D
0.00
0.00
0.00
0.00
0.00
0.00
o.00
0.00
$0.00
$19.36
$0.00
$0.00
$0.00
$1,404.4
$0.00 $367.80 4
Other Deduction Notes: Trainina. GARNISHMENT
t
S
0.00
0.00
4.00
4.00
4.00
4.00
0.00
16.00
$52.14
r1-\; _
PROJECT
_ 11LL 1%-J 6
PROJECTS Tax
M13 d
Medicare
9iattr
Tax
SDI
umcut auattort- ea ... _._
Holiday Welfare Pension
COWAN, THOMAS
12650 C
PLUMBER/
$553.00
$227.72
$223.17
$32.75
$0.00 $0.00 $0.00
Shenandoah Road
0
ND UTILITY
UNDERGROUwow
O
0.00
0.00
2.00
2.00
2.00
2.00
0.00
8.00
$68.79
$1,602.34 D/D
5669
PIPEFITTER
$1,384.56
$3,006.78 Training
Admin /
Dues
Travel &
Total
Savings Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$9.60
$0.00
$0.00
$0.00
$1,404.4
$0.00 $367.80 4
Other Deduction Notes: Training. GARNISHMENT
(
S
0.00
0.00
4.50
0.00
6.00
0.00
0.00
10.50
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
GABREE, PAUL
611
PLUMBER /
$0.00
$177.03
$0.00
$25.46
$0.00 $0.00 $0.00
Glenbrook Drive
3
UNDERGROU
ND UTILITY
O
0.00
0.00
2.00
0.00
2.00
0.00
0.00
4.00
$68.79
$2,111.68 D/D
�0
PIPEFITTER
�
$822.63
$2,320.57 Training
Admin /
Dues
Travel &
Savings Other Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$5.80
$0.00
$0.00
$0.00
$0.00 $6.40 $208.89
Other Deduction Notes: Training
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
GARIBALDI,
ANTHONY
PLUMBER /
$433.00
$189.44
$171.98
$27.24
$0.00 $0.00 $0.00
P. O. Box 985 Sutter
0
UNDERGROU
ND UTILITY
O
0.00
0.00
2.00
2.00
2.00
2.00
0.00
8.00
$68.79
$1,654.70 D/D
85
PIPEFITTER
$2,218.80
$2,493.96 Training
Admin /
Dues
Travel &
Savings Other Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$16.00
$0.00
$0.00
$0.00
$0.00 $17.60 $839.26
Other Deduction Notes: Training fee
S = STRAIGHT TIME 'OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. (See reverse side)
Form A-1-131 (New 2-80) D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
JON
Department of
Herbert
Walkup Pipeline Replacement
Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 3 of 7
(1)
(2) 1 (3)
(4) DAY
(5)
(6)
(7)
(8)
S I
M I
T
I W I
T I
F
I S
NAME,ADDRESS
AND SOCIAL
'Co' WORK
o f
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES CHECK
SECURITYNUMBER
oo� CLASS
Z IFICATION
5/26 15/27
15/28
15/29 15/30
15/31
16/01
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO,
EMPLOYEE
3 i
FOR
Hours Worked Each Day
WEEK
I
S
0.00
0.00
8.00
8.00
8.00
4,50
0.00
28.50
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
pension
GIRARDIN, FLOYD
P. O. Box
PLUMBER /
$295.00
$157.28
$125.92
$22.61
$0.00
$0.00
$0.00
102 River
75
1 UNDERGROU
ND UTILITY
O
O.DO
0.00
2.00
2.00
2.00
0.00
0.00
6.00
$68.79
$1,455.10 D/D
�
PIPEFITTER
$1,898.73
$2,070.71 Training
Admin /
D
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
�
$13.80
$0.00
$0.00
$0.00
$0.00
$14.80
$615.61
Other Deduction Notes: Tr inin
_
Ti X',2 . .
_ . " I-: z.,
; I PrB State
SDI
�1��6 ,r
I I..Ah rx
Pension
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
GRIEGO, DAVID
1730 Rock Springs
PLUMBER /
UNDERGROU
$344.00
$173.75
$150.99
$24.99
$0.00
$0.00
$0.00
Road Escondido CA
0 ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68.79
$1,577.46 D/D
9202=
PI
I PIPEFITTER
$2,184.41
$2,287.59 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
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
$16.40
$710.13
Other Deduction Notes: Training
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
LIMAS, ABRAHAM
1535 Hussman
PLUMBER/
UNDERGROU
$82.00
$168.51
$71.79
$24.23
$0.00
$0.00
$0.00
Avenue Gardnerville
0 ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68.79
$1,856.27 2336
PIPEFITTER
$2,184.41
$2,218.80 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other
Total
Deduct.
D
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
$16.00
$362.53
Other Deduction Notes: Trainin❑
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Holiday
Health &
Welfare
Pension
MERCIER,
I
BRANDON
400 Cragmont Court
PLUMBER /
UNDERGROU
$392.00
$192.06
$172.43
$27.62
$0.00
$0.00
$0.00
Cameron Park CA
1 ND UTILITY
O
0.00
0.00
2.00
2.00
2.00
2.00
0.00
8.00
$68.79
$1,726.45 D/D
PIPEFITTER
$2,218.80
$2,528.36 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$16.00
$0.00
$0.00
$0.00
$0.00
$17.80
$801.91
Other Deduction Notes: Training
S = STRAIGHT TIME "OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
California
Department of
Herbert
Walkup Pipeline Replacement
/ Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 4 of 7
(1)
(2) 1 (3)
'
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME,ADDRESS
AND SOCIAL
LLoo' WORK
o 0 0
Date
TOTAL
HOURL
GROSS AMOUNT
NET
WAGES CHECK
SECURITYNUMBER
d i , CLASS-
Z IFICATION
5/26 15/27
15/28
15/29 15/30
1
5/31 16/01
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
EMPLOYEE OYEE
3'- i
FOR
Hours Worked Each
Day
WEEK
I
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
PASTEN
I
VELASQUEZ,
ELIBourn
PLUMBER/
UNDERGROU
$130,00
$168.51
$134.85
$24.23
$0.00
$0.00
$0.00
742 Bo
742 Dr
0
� ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68 .79
$1,745.21 D/D
95776
I PIPEFITTER
$2,184.41
$2,218.80 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
�
D
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
$0.00
$16.00
$473.59
Other Deduction Notes: Training fee
1
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS--=
PROJECT
ALL -Federal-
PROJECTS Tax
=FWA & \�t�
Medicare Tax
SDI
'lacation-+i�a1-1„ «
Holiday Welfare
Pension
PEREZ, SERGIO
' PLUMBER /
$394.00
$183.36
$160.81
$26.36
$0.00
$0.00
$0.00
149 Oak Ridge Drive
lone C 95 0
1 UNDERGROU
ND UTILITY
O
O.OD
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68.79
$1,632.47 D/D
' PIPEFITTER
$2,184.41
$2,413.20 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
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
$780.73
Other Deduction Notes: Training Fee
i
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
REYNOSO, LUIS
8399 Steelhead
PLUMBER /
UNDERGROU
$328.00
$168.51
$143.99
$24.23
$0.00
$0.00
$0.00
Avenue Kings Beach
0 ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68.79
$1,538.07 D/D
PIPEFITTER
$2,184.41
$2,218.80 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other
Total
Deduct.
D
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
$16.00
$680.73
Other Deduction Notes: Training
1
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
SABIA, MORGAN
1413 Rancho Way
pLUMBER /
$328.00
$168.52
$143.99
$24.23
$0.00
$0.00
$0.00
South Lake Tahoe
UNDERGROU
0
ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2.00
0.00
7.50
$68.79
$1,538.06 D/D
CACA 96�
PIPEFITTER
$2,184.41
$2,218.80 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
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
$16.00
$680.74
Other Deduction Notes: Training fee
S = STRAIGHT TIME 'OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
California
am
21
Department
of
Herbert
Walkup Pipeline Replacement Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 5 of 7
(1)
(2) 1 (3)
I
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
?zI
o o
o o WORK a
Date
TOTAL
HouRL
GROSS AMOUNT
NET
WAGES CHECK
SECURITY NUMBER
o i w IFICAT O
5/26 I
5/27 I
5/28
5/29
I I
5/30 I
5/31 6/01
I
HOURS
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID NO.
OF EMPLOYEE
3
FOR
Hours Worked Each
Day
WEEK
I
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
VASQUEZ, LUIS
210 Rosa
, PLUMBER/
$101.00
$168.52
$134.85
$24.23
$0.00
$0.00 $0.00
Ave
Winters 94
0 UNDERGROU
ND UTILITY
O
0.00
0.00
2.00
2.00
1.50
2,00
0.00
7.50
$68.79
$1,774.20 DID
PIPEFITTER
$2,184.41
$2,218.80 Training
Admin /
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
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
$16.00 $444.60
Other Deduction Notes: Training fee
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$95.64
71 \V
PROJECT
PROJECTS Tax
F13A G
Medicare
3
Tax
SDI
u., J6,;-
Holiday
'H;o6J, G
Welfare Pension
VINCIGUERRA,
Operating
330 BodTIN
30 odega Court El
Engineer
$127.0
$521.00
$284.08
$292.45
$40.85
$0.00
$0.00 $0.00
Dorado Hills CA
2 (Heavy &
O
0.00
0.00
2.00
2.00
0.00
0.00
O.DO
4.00
0
$2,575.22 DID
95
Highway work) /
Group 3 Area 1
$3,568.48
$3,758.98 Training
Admin /
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$43.56
$0.00
$0.00
$0.00
$0.00
$1,183.7
$45.38 6
Other Deduction Notes. Training fee
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$95.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
VINCIGUERRA,
Operating
CASEY
Engineer
� 9
$527.00
$298.53
$305.66
$42.93
$0.00
$0.00 $0.00
470 Broadmeadows
Court Sutter Creek
4
O
0.00
0.00
1.00
2.00
2.00
2.00
0.00
7.00
$127.0
0
$2,491.20 DID
Highway work) /
Group 3 Area 1
$3,949.48
$3,949.48 Training
Admin /
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$47.19
$0.00
$0.00
$0.00
$0.00
$284.16 $1,458.22
Other
Deduction Notes: Trainino fee. Cal savers
S
0.00
0.00
8.00
8.00
8.00
8.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
WILLSON, SLOAN
3020 Newton Road,
PLUMBER /
$349.00
$181.60
$152.34
$26.11
$0.00
$0.00 $0.00
Sp. 1 Placerville CA
UNDERGR
5 ND UTILITY
O
0.00
0.00
2.00
2.00
2.00
2.00
0.00
8.00
$68.79
$1,549.35 DID
JI
PIPEFITTER
$2,218.80
$2,390.78 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$16.00
$0.00
$0.00
$0.00
$0.00
$132.38 $841.43
Other Deduction Notes: Trainina fee. Garnishment
S = STRAIGHT TIME *OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
Form A-1-131 (New 2-80) O = OVERTIME Use extra sheets d necessary. t )
D = DOUBLETIME () ry• See reverse side
SDI = STATE DISABILITY INSURANCE
California
i15
Department of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 6 of 7
(1)
(2)
1 (3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
8 I M I T I W I T I F
I S
NAME, ADDRESS
AND SOCIAL
(El zI
00
o o a
WORK
I
Date
TOTAL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
o= w
CLASS-
IFICATION
5/26 15/27 15/28 15/29 15/30 15/31 16/01
HOURS
Y RATE
RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
r
FOR
3
Hours Worked Each Day
WEEK
I
S
0.00 0.00 8.00 8.00 8.00 8.00
0.00
32.00
$95.64
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
YOUNG, JIM
Operating
Engineer
$650.00
$322.58
$346.97
$46.39
$0.00 $0.00 $0.00
P. O. Box 58
95629
1
(Heavy &
O
0.00 0,00 2.00 2.00 2.00 2.00
0.00
8.00
$127.0
0
$2,594.80 D/D
Highway work) /
Group 3 Area 1
$4,076.48 $4,266.98 Training
Admin !
Fringes
Dues
Travel &
Sub
Total
Savings Other Deduct.
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
$48.40
$0.00
$0.00
$0.00
672 ,. $11
$0.00 $306.24 8
Other Deduction Notes Trainino fee. Cal Savers
-- -
S
0.00 0.00 8.00 8.00 8.00 8.00
0.00
32.00
$52.14
Ti�` - G,
PROJECT PROJECTS Tax
-'IT Q
Medicare
JtGtu
Tax
SDI
lU�G,„v. ' I Iooltt1&-
Pension _ _
Holiday Welfare
ZELLERS,JEREMY
8194 MAIN ST
PLUMBER!
UNDERGROU
$275.00
$176.36
$148.39
$25.36
$0.00 $0.00 $0.00
MOKELUMNE HILL
0
ND UTILITY
O
0.00 0.00 2.00 2.00 2.00 2.00
0.00
8.00
$68.79
$1,539.28 D/D
CA 95245
PIPEFITTER
$2,218.80 $2,321.99 Training
Admin /
Dues
Travel &
Total
Savings Other
-
Fringes
Sub
Deduct,
D
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
$0.00
$16.00
$0.00
$0.00
$0.00
$0.00 $157.60 $782.71
Other Deduction Notes: Trainino fee. Garnishment
S = STRAIGHT TIME ^OTHER- Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
J01 California
Department of
Industrial Relations
FATE OF CALIFORNIA
rATEMENT OF COMPLIANCE
DNTRACTOR/SUBCONTRACTOR
Vinciguerra Construction, Inc.
RST DAY AND DATE OF PAY PERIOD
5/26/2024
to hereby certify under penalty of perjury:
Herbert Walkup Pipeline Replacement / Herbert Walkup Pipeline
PUBLIC WORKS PAYROLL REPORTING FORM Page 7 of 7
CONTRACT NUMBER
Herbert Walkup Pipeline
LAST DAY AND DATE OF PAY PERIOD
6/1/2024
(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
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) ❑X 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 laporer 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) 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) ❑X Have been paid directly to the listed employee(s), except as noted below.
(c) See exceptions noted below.
EXCEPTION CRAFT
EXPLANATION
MARKS: Except for Training funds for all crafts paid directly to CAC.
NME (PLEASE PRINT.) TITLE
istin Vinciguerra �_------ President
GNATURE:) DATE
6/26/2024
i 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. ,'276c). Also, the willful
Isification 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 title 31 of the Y91ted States Code).
OA Notice For 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 �pd Forms CEM 2503
Management, 1120 N Street, MS-89, Sacramento, CA 95814.
in California
Department of Herbert Walkup Pipeline Replacement /Herbert Walkup Pipeline
21
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of 7
1 NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S LICENSE NO.: 358838 ADDRESS: P. O. Box 157, Sutter Creek, CA, 95685j
OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: 1
t PAYROLL NO. FOR WEEK ENDING: SELF -INSURED CERT: PROJECT OR CONTRACT NO.: Herbert Walkup Pipeline
9 I 6/8/2024 (WORKERS' COMP: IPROJECT AND LOCATION: Herbert Walkup Pipeline Replacement, ELD
(1) (2) 1 (3) (4) DAY (5) (6) (7) (8)
(9)
I 9 I M I T I W I T I F I S
NAME, ADDRESS ?zI NET
0 o WORK Date HOURL WAGES CHECK
AND SOCIAL o � 7 I TOTAL GROSS AMOUNT
o a CLASS- Y RATE DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER oz=2 IFICATION 6/02I6l03I6/04I6105I6/06I6/07I6/08 HOURS OF PAY EARNED
OF EMPLOYEE �x FOR
3
Hours Worked Each Day WEEK
' THIS ALL Federal FICA & State SDI Vacation Health & Pension
S 0.00 4.00 4.00 4.00 4.00 4.00 0.00 20.00 $90.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
AREVALO, JOSHUA Operating
155 Hillside Place Engineer $550.00 $300.34 $320.27 $43.19 $0.00 $0.00 $0.00
�
4 (Heavy & 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $119.5 642 p $2,358.92 D/D
Highway work) / Admin / Travel & Total
Group 3 Area 1 $1,812.80 $3,964.57 Training Fringes Dues Sub Savings Other Deduct.
_u- _0.00 0.00 U 00 0.00 ..0.00 0 00 0.00 0.00 $0.00 _ '
I I $1 605 5
$24.20 $0.00 $0.00 $0.00 $0.00 $391.85
Other Deduction Notes: Trainina fee. Garnishment. and CalSavers Contrib,
THIS ALL Federal FICA & State Vacation Health &
S 0.00 4.00 4.00 4.00 4.00 4.00 0.00 20.00 $52.14 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension
AREVALO, JOSHUA I PLUMBER / $550.00 $300.34 $320.27 $43.19 $0.00 $0.00 $0.00
155 Hillside Place UNDERGROU
Jackson CA 95642 4 NO UTILITY O 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10.00 $68.79 $2,358.92 D/D
_ PIPEFITTER $1,730.70 $3,964.57 Training Admin / Dues Travel & Savings Other Total
Fringes Sub Deduct.
D 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 $391.85 $1,605.6
Other Deduction Notes: Training Fee. Garnishment. and CalSavers Contrih.
1 THIS ALL Federal FICA & State SDI Vacation Health & pension
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.14 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare
CORREA, ERICK PLUMBER /
1535 Hussman $64.00 $165.90 $74.39 $23.85 $0.00 $0.00 $0.00
UNDERGROU
Avenue Gardnerville 0 NO UTILITY O 0.00 2.00 2.00 1.50 0.50 0.00 0.00 6.00 $68.79 $1,840.47 2340
PIPEFITTER $2,081.22 $2,184.41 Training Admin / Dues Travel & SavingTotal
Fringes s Other Sub Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $15.80 $343.94
Other Deduction Notes: Training fee
S = STRAIGHT TIME 'OTHER- Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Farm A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
Department
of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
rJORCalifornia
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 2 of 7
(1)
(2) 1
(3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
LL a o 1
o o a
WORK
Date
TOTAL
HouRL
GROSS AMOUNT
NET
WAGES CHECK
SECURITY NUMBER
Z=
CLASS-
IFICATION
6/02I6l03I6/04I6/05I6I06I6/07I6/08
HOURS
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
3
FOR
(
Hours Worked Each Day
WEEK
I
S
0.00
4.00
4.00
4.00
4.00
0.00
0.00
16.00
$90.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
COWAN, THOMAS
Operating
12650 C
Engineer
$537.00
$222.50
$216.18
$31,99
$0.00
$0.00 $0.00
Shenandoah Road
0
(Heavy &
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$119.55
$1,562.92 D/D
669
Highway work) /
Group 3
$1,450.24
$2,937.99 Training
Admin /
Dues
Travel &
Savings
Other Total
Area 1
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$19.36
$0.00
$0.00
$0.00
$0.00
375 ,. $10
$367.40 7
Other Deduction Notes: Training Fee and Garnishment
t
Ti
ALL 7�J: l
Ff3A&
-P�,I.
SDI
V.d;i r
;Ieal:)r&.
Pension
S
0.00
4.00
4.00
4.00
4.00
0.00
0.00
16.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
COWAN, THOMAS
12650 C
PLUMBER/
$537.00
$222.50
$216.18
$31.99
$0.00
$0.00 $0.00
Shenandoah Road
0
UNDERGROU
ND UTILITY
O
0.00
2.00
2.00
2.00
1.00
0.00
0.00
7.00
$68.79
$1,562.92 D/D
669
PIPEFITTER
$1,315.77
$2,937.99 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Total
Other Deduct.
�
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$9.20
$0.00
$0.00
$0.00
$0.00
$1375.0
,
$367.40 7
Other Deduction Notes: Trainina Fee and Garnishment
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health &
Pension
S
0.00
6.00
0.00
8.00
8.00
8.00
0.00
30.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
GABREE, PAUL
'
PLUMBER /
$0.00
$217.68
$0.00
$31.30
$0.00
$0.00 $0.00
611 Glenbrook Drive
3
UNDERGROU
ND UTILITY
O
0.00
2.00
0.00
2.00
2.00
0.00
0.00
6.00
$68.79
$2,596.55 D/D
�
PIPEFITTER
$1,976.94
$2,861.13 Training
Admin /
Dues
Travel &
Savings
Other Total
Fringes
Sub
Deduct.
'
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$14.40
$0.00
$0.00
$0.00
$0.00
$15.60 $264.58
Other Deduction Notes: Trainina Fee
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health &
Pension
S
0.00
0.00
8.00
8.00
8.00
0.00
0.00
24.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
GARIBALDI,
ANTHONY
PLUMBER /
$220.00
$118.54
$77.16
$17.04
$0.00
$0.00 $0.00
P. O. Box 985 Sutter
0
UNDERGROU
ND UTILITY
O
0.00
0.00
2.00
1.00
1.00
0.00
0.00
4.00
$68.79
$1,116.78 D/D
5
�
PIPEFITTER
$1,526.52
$1,560.92 Training
Admin /
Dues
Travel &
Savings
Total
Other
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$11.20
$0.00
$0.00
$0.00
$0.00
$11.40 $444.14
Other Deduction Notes: Trainina Fee
S = STRAIGHT TIME "OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra shoot(s) if necessary. (See reverse side)
Form A-1-131 (New 2--80) D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
JWNCalifornia
Department of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS
PAYROLL REPORTING
FORM
Page 3 of 7
(1)
(2) 1
(3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME,ADDRESS
AND SOCIAL
?zI
LLao
o �
WORK
Date
TOTAL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
o = z
CLASS
IFICATION
6/02 16/03
16/04
16/05 16/06
16/07 16/08
HOURS
RATE
Y RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
3
FOR
Hours Worked Each Day
WEEK
I
THIS
ALL Federal
FICA &
State
SDI
Vacation
Health &
S
0.00
8.00
8.00
8.00
8.00
0.00
0.00
32.00
$52.14
PROJECT
PROJECTS Tax
Medicare
Tax
Holiday
Welfare
Pension
GIRARDIN, FLOYD
P. O. Box 102 River
I
PLUMBER /
UNDERGROU
$369.00
$181.60
$158.44
$26.12
$0.00
$0.00
$0.00
75
1
ND UTILITY
O
0.00
2.00
2.00
2.00
1.50
0.00
0.00
7.50
$68.79
$1,638.62 D/D
�
PIPEFITTER
$2,184.41
$2,390.78 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
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
$17.00
$752.16
Other Deduction Notes: Training Fee
S
0.00
8.00
8.00
8.00
8.00
0.00
0.00
32.00
$52.14
TI IIC- -..
PROJECT
_ _- A F.J.,ol
PROJECTS Tax
FICA G
Medicare
G,d'e
Tax
SDI
vacation
Holiday
Flea :n
Welfare
Pension
GRIEGO, DAVID
1730 Rock Springs
PLUMBER /
$369.00
$181.60
$161.48
$26.11
$0.00
$0.00
$0.00
Road Escondido CA
0
UNDERGROU
ND UTILITY
O
0.00
2.00
2.00
2.00
1.50
0.00
0.00
7.50
$68.79
$1,635.59 D/D
9
PIPEFITTER
$2,184.41
$2,390.78 Training
Admin !
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
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
$17.00
$755.19
Other Deduction Notes: Training Fee
S
0.00
8.00
8.00
8.00
8.00
0.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare
Pension
LIMAS, ABRAHAM
PLUMBER /
1535 Hussman
�
$74.00
$165.90
$68.29
$23.86
$0.00
$0.00
$0.00
Avenue Gardnerville
0
UNDERGROU
ND UTILITY
O
0.00
2.00
2.00
1.50
0.50
0.00
0.00
6.00
$68.79
$1,836.56 2341
NV 89410
-
�
PIPEFITTER
$2,081.22
$2,184.41 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$15.20
$0.00
$0.00
$0.00
$0.00
$15.80
$347.85
Other Deduction Notes: Trainina Fee
S
0.00
8.00
8.00
8.00
8.00
2.00
0.00
34.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Heath &
l
Welfare
Pension
MERCIER,
I
BRANDON
PLUMBER/
$0.00
$209.73
$0.00
$30.16
$0.00
$0.00
$0.00
400 Cragmont Court
Cameron Park CA
1
UNDERGROU
ND UTILITY
O
0.00
1.50
2.00
2.00
2.00
0.00
0.00
7.50
$68.79
$2,501.70 D/D
�
PIPEFITTER
$2,288.69
$2,760.79 Training
Admin /
Dues
Travel &
Savings
Other
Total
Fringes
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$16.60
$0.00
$0.00
$0.00
$0.00
$19.20
$259.09
Other Deduction Notes: Training Fee
S = STRAIGHT TIME 'OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( i
SDI = STATE DISABILITY INSURANCE
aO California
Department of Herbert Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of 7
(1) (2) 1 (3) (4) DAY (5) (6) (7) (8)
(9>
1 I
S I M I T I W I T I F I S
NAME, ADDRESS ?z I NET
WAGES
LLoo WORK CHECK
AND SOCIAL o' Date TOTAL HOA E GROSS AMOUNT
o a CLASS- Y RATE DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID NO.
SECURITY NUMBER °= W IFICATION 6/02 16/03 16/04 16I05 16/06 16/07 16/08 HouRS of PAY EARNED
OF EMPLOYEE 3 FOR
Hours Worked Each Day WEEK
I THIS ALL Federal FICA & State Vacation Health &
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.14 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension
PASTEN
VELASQUEZ, PLUMBER / $126.00 $165.89 $131.35 $23.85 $0.00 $0.00 $0.00
ELISIO 1 UNDERGROU
742 Bourn Dr 0 1 ND UTILITY O 0.00 2.00 2.00 1.50 0.50 0.00 0.00 6.00 $68.79 $1,721.52 DID
95776 PIPEFITTER $2,081.22 $2,184.41 Training Admin / Dues Travel & Savings Other Total
Fringes Sub Deduct.
�
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $15,80 $462.89
Other Deduction Notes: Training Fee
S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $60.00 PROJECT PRO,L F: Jt...�l- -MOA A - 3,.io tfaoaiiorr
JECTS Tax Medicare Tax SDI Holiday Welfare Pension
PEREZ,SERGIO PLUMBER/ $293.00 $150.16 $116.39 $21.59 $0.00 $0.00 $0.00
149 Oak Ridge Drive 1 UNDERGROU O 0.00 0.00 O.DO 0.00 0.00 0.00 0.00 0.00 $80.58
lone CA 95640 ND UTILITY $1,381.65 DID
Admin / Travel & Total
PIPEFITTER $480.00 $1,965.99 Training Fringes Dues Sub Savings Other Deduct.
( D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
$3.20 $0.00 $0.00 $0.00 $0.00 $3.20 $584.34
Other Deduction Notes: Trainina Fee
1 THIS ALL Federal FICA & State Vacation Health &
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.14 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare pension
REYNOSO, LUIS pLUMBER /
8399 Steelhead UNDERGR $320.00 $165.89 $140.49 $23.86 $0.00 $0.00 $0.00
Avenue Kings Beach 0 ND UTILITY O 0.00 2.00 2.00 1.50 0.50 0.00 0.00 6.00 $68.79 $1,518.37 DID
PIPEFITTER $2,081.22 $2,184.41 Training Admin / Dues Travel & Savings Other Total
Fringes Sub Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $15.20 $0.00 $0,00 $0.00 $0.00 $15.80 $666.04
Other Deduction Notes: Trainino Fee
i THIS ALL Federal FICA & State Vacation Health &
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $52.14 PROJECT PROJECTS Tax Medicare Tax SDI Holiday Welfare Pension
SABIA, MORGAN pLUMBER /
1413 Rancho Way UNDERGR $328.00 $168.51 $143.99 $24.23 $0.00 $0.00 $0.00
South Lake Tahoe 0 ND UTILITY O 0,00 2.00 2.00 2.00 0.50 0.00 0.00 6.50 $68.79 $1,538.07 DID
PIPEFITTER $2,115.62 $2,218.80 Training Admin / Dues Travel & Savings Other Total
� Fringes Sub Deduct.
D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00
$15.40 $0.00 $0.00 $0.00 $0.00 $16.D0 $680.73
Other Deduction Notes: Trainina Fee
S = STRAIGHT TIME ^OTHER- Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 (New 2-80) D = DOUBLETIME ( )
SDI = STATE DISABILITY INSURANCE
California
Department of
Herbert
Walkup Pipeline Replacement / Herbert Walkup Pipeline
Industrial
Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 5 of 7
(1)
(2) 1 (3)
I
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I
M I
T
I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
z z 1
moo WORK
ooa I
Date
TOTAL
GROSS AMOUNT
NET
WAGES
CHECK
SECURITY NUMBER
CLASS-
�T' IFICATION
6/02 16/03
16/04
16/05 i
6/06 16/07
16/OS
HOURS
RATE
OF PAY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID
NO.
OF EMPLOYEE
3 w
FOR
Hours Worked Each Day
WEEK
I
S
0.00
8.00
8.00
8.00
8.00
0.00
0.00
32.00
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health & pension
Welfare
VASQUEZ, LUIS
210 Rosa Ave
PLUMBER/
UNDERGROU
$97.00
$165.89
$131.35
$23.85
$0.00
$0.00 $0.00
694
0 ND UTILITY
O
0.00
2.00
2.00
1.50
0.50
0.00
0.00
6.00
$68.79
$1,750.52 D/D
PIPEFITTER
$2,081.22
$2,184.41 Training
Admin!
Dues
Travel&
Savings
Other Total
Fringes
Sub
Deduct.
�
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$15,20
$0.00
$0.00
$0.00
$0.00
$15.80 $433.89
Other Deduction Notes: Training Fee
1
S
0.00
8.00
8.00
8.00
8.00
0.00
0.00
32.00
$95.64
TIJICv
PROJECT
ALL : ✓ ,6-
PROJECTS Tax
-; IG1, d
Medicare
J;atc
Tax
SDI
4aeatiorrHeaNii &
Holiday Welfare Pension
VINCIGUERRA,
Operating
330 BodTIN
odega Court El
Engineer
$127.0
$549.00
$293.71
$305.32
$42.23
$0.00
$0.00 $0.00
Dorado
Dorado Hills CA
2 (Heavy &
O
0.00
2.00
2.00
0.00
0.00
0.00
0.00
4.00
0
$2,649.13 D/D
Highway work) /
Group 3 Area 1
$3,568.48
$3,885.98 Training
Admin /
Fringes
Dues
Travel &
Savings
Total
Other
Sub
Deduct.
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$43.56
$0.00
$0.00
$0.00
$0.00
236 ,. $18
$46.59 5
Other Deduction Notes: Training Fee
1
S
0.00
8.00
8.00
8.00
8.00
2.00
0.00
34.00
$95.64
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health &
Welfare Pension
VINCIGUERRA,
Operating
CASEY
Engineer
9
$485.00
$284.10
$286.38
$40.85
$0.00
$0.00 $0.00
470 Broadmeadows
Court Sutter Creek
4 I (Heavy &
O
0.00
0.00
0.00
2.00
2.00
0.00
0.00
4.00
$127.0
0
$2,391.86 D/D
Highway work) /
Group 3 Area 1
$3,759.76
$3,759.76 Training
Admin /
Dues
Travel &
Savings
Other Total
Fringes
Sub
Deduct.
D
0.00
0,00
0.00
0.00
0.00
0.00
0.00
0,00
$0.00
$45.98
$0.00
$0.00
$0.00
$0.00
367 ,. $19
$271.57 0
Other Deduction Notes: Trainino Fee and CalSavers Contrib.
1
S
0.00
8.00
8.00
8.00
5.50
0.00
0.00
29.50
$52.14
THIS
PROJECT
ALL Federal
PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation
Holiday
Health & pension
Welfare
WILLSON, SLOAN
3020 Newton Road,
PLUMBER /
� UNDERGROU
$289.00
$161.23
$125.12
$23.18
$0.00
$0.00 $0.00
Sp, 1 Placerville CA
5 ND UTILITY
O
0.00
2.00
2.00
2.00
0.00
0.00
0.00
6.00
$68.79
$1,393.74 D/D
PIPEFITTER
$1,950.87
$2,122.85 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings
Other Total
Deduct.
�
D
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00
$14.20
$0.00
$0.00
$0.00
$0.00
$130.58 $729.11
Other Deduction Notes: Trainina Fee and Garnishment
S = STRAIGHT TIME °OTHER- Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side) Form A-1-131 (New 2-80) D = DOUBLETIME
(
SDI = STATE DISABILITY INSURANCE
MOM
California
Department of
Herbert
Walkup Pipeline Replacement Herbert Walkup Pipeline
Industrial Relations
PUBLIC WORKS PAYROLL REPORTING
FORM
Page 6 of 7
(1)
(2) I
(3)
(4) DAY
(5)
(6)
(7)
(8)
(9)
S I M I T I W I
T I
F
I S
NAME, ADDRESS
AND SOCIAL
u o o 1
ooa
WORK
CLASS -TOTAL
Date
HOURL
GROSSAMOUNT
NET
WAGES CHECK
SECURITY NUMBER
°= W
I ICAT O
6/02 6/03 6/04 6/05
I I I I
6/06 I
6/07 6/08
I
HouRs
Y RATE
OF AY
EARNED
DEDUCTIONS, CONTRIBUTIONS
AND PAYMENTS PAID NO.
OF EMPLOYEE
3
FOR
Hours Worked Each Day
WEEK
I
S
0.00 8.00 0.00 0.00
8.00
0.00
0.00
16.00
$95.64
THIS ALL Federal
PROJECT PROJECTS Tax
FICA &
Medicare
State
Tax
SDI
Vacation Health &
Holiday Welfare Pension
YOUNG, JIM
Operating
Engineer
$185.00
$154.08
$121.63
$22.15
$0.00 $0.00 $0.00
P. O. Box 58
95629
1 I
(Heavy &
O
0.00 2.00 0.00 0.00
2.00
0.00
0.00
4.00
$127 0
0
$1,408.89 D/D
Highway work) /
Group 3 Area 1
$2,038.24 $2,038.24 Training
Admin /
Fringes
Dues
Travel &
Sub
Savings Other Total
Deduct.
D
0.00 0.00 0.00 0.00
0.00
0.00
0.00
0.00
$0.00
$24.20
$0.00
$0.00
$0.00
$0.00 $146.49 $629.35
Other Deduction Notes: Training Fee and CalSavers Contrib.
;.=HIS --A ram - -Federal---F e*-8r°3tal.
SDI
acatit7n�fiiealth 8
Pension
�
S
0.00 8.00 8.00 8.00
7.00
0.00
0.00
31.00
$52.14
PROJECT PROJECTS Tax
Medicare
Tax
Holiday Welfare
ZELLERS,JEREMY
8194 MAIN ST
1
PLUMBER/
$255.00
$169.79
$139.60
$24.42
$0.00 $0.00 $0.00
MNE HILL
0
UNDERGROU
ND UTILITY
O
0.00 2.00 2.00 2.00
0.00
0.00
0.00
6.00
$68.79
$1,489.64 D/D
CA 9524
CA 95245
I
PIPEFITTER
$2,029.08 $2,235.45 Training
Admin /
Fringes
Dues
Travel &
Savings Other Total
Sub
Deduct.
�
D
0.00 0.00 0.00 0.00
0.00
0.00
0.00
0.00
$0.00
$14.80
$0.00
$0.00
$0.00
$0.00 $157.00 $745.81
Other Deduction Notes: Training Fee and Garnishment
S = STRAIGHT TIME *OTHER - Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. CERTIFICATION MUST be completed
O = OVERTIME Use extra sheet(s) if necessary. See reverse side
Form A-1-131 New 2-80) ( )
( D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
California
Department of
Industrial Relations
FATE OF CALIFORNIA
rATEMENT OF COMPLIANCE
DNTRACTOR/SUBCONTRACTOR
Vinciguerra Construction, Inc.
RST DAY AND DATE OF PAY PERIOD
6/2/2024
to hereby certify under penalty of perjury:
Herbert Walkup Pipeline Replacement / Herbert Walkup Pipeline
PUBLIC WORKS PAYROLL REPORTING FORM Page 7 of 7
CONTRACT NUMBER
Herbert Walkup Pipeline
LAST DAY AND DATE OF PAY PERIOD
6/8/2024
(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
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) M Specified in the applicable wage determination incorporated into the contract;
(b) �X 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) 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) FX1 Have been paid directly to the listed employee(s), except as noted below.
(c) See exceptions noted below.
EXCEPTION CRAFT EXPLANATION
MARKS: Except for Training funds for all crafts paid directly to CAC.
4ME (PLEASE PRINT.) TITLE
istin Vinciguerra president
GNATURE:I DATE
G 6/27/2024
i 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
Isification 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 title 31 of the United States Code).
)A Notice For 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 OEM 2503
Management, 1120 N Street, MS-89, Sacramento, CA 95814.