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Certified Payroll Records 15 thru 19_Redactedfornia Departme 2024 Herbert Walkup Pipeline Replacement I Herbert Walkup Pipeline Dcpanmentaf Industrial ftWkans PUBLIC WORKS PAYROLL REPORTING FORM page tofE I NAME OF CONTRACTOR- Vinciguerra Cos irtwMn, Inc. CONTRACTOR'S LICENSE NO.: 358838 ADDRESS. P. O. Box 157, Sutter Creek, CA, 9%89� OR SUBCONTRACTOR SPECIALTY LICENSE NO.: PAYROLL NO. FOR WEEK ENDING. `SELF-4NSURED CERT: (PROJECT OR COHITRACT NO, Herbert Walkup Pipeline I 15 T2012024 IWORKERS COMP iPROJECT AND LOCATION2024 Herbert Walkup Pipeline Replacement, ELD (1) (2) 1 (3) (4) DAY (5) (6) (71 (5} (g) sIMITIWITIFI8 NET NAME, ADDRESS ag I WORK Date Hou>ZL AND SOCIAL t9= I TQTAL GROSS AMOUNT WAGES CHECK CLASS-SECURITYNUMBER �� I IFICATION-F14I7I15I7116I7117I7118I7119 7120 IIOURS OF PAY EARNED DEDUGTFON$,CUNTRIB1J710NSANDPAYIuIENTS POOR NO OF EMPLOYEE g w I WEEK Haws Worked Each Day THIS ALL Federal FICA & State SDI Vacation Health & Pension I S i ODD 0.00 0.00 U0 0A0' 0.00 0.00 0.00 $W.64 PROJECT PROJECTS Tax Medicare Tax 1`1011day Welfare AREVALO, JOSHUA I PLUMSER1 $0.00 50.00 $0.00 $0-00 3D.00 $0,00 $0.00 156 Hillside Place ( UNDER,GROl1 $1%5 $0.00 � 4 O 0.00 OA0 0.00 0.00 000 0.00 0.04 0.00 5b42 NO UTILITY O Adrriin ! Travee€ & Tgl I PIPfFTfTER i$0.0050-ofl Training Fringes Dues Sub Savirlga Other Oedurx. I - - - v uuu U.1R-Di m A0 -A6 --aw � 0.00 0.00 Soup I $0.Oi1 $0-00 50-00 SO-00 $0.04I S0,00 50.170 Other Deduction Notes'. Trainng te.G-mishmertQn' Save I THIS AL_ Federal FICA & State Vacation Health & S 0,00 4.0D 4.00 3.50 0.00 0.00 0.00 11.50 S94.64 PROJECT PROJECTS Tax Medicare Tax SO1 Hal" Welfare Pension COWAN. THOMAS Operating 12650 C ( Engineer 5295.00 $144,42 8711.76 $20.78 $0_r%1 $0.00 60-00 $125.2 Shenandoah Road 0 I (Heavy & 4 0.00 0.00 0-00 0-00 0,00 0-00 0-00 0.00 1 $977.93 DID low%59 Highway work) I $1,088.36 S1,907.03 Training Adrnirt 1 Dues Travel & Total Savings Other I Group 3 Area 1 Fridges Sub Deduct I D 0.00 0.00 0.00 0.00 O.DD 0.00 Q.00 0.00 $0-00 $13.92 SO.00 W-00 %,00 SO-00 $357.16 $929-10 I (Other Deducbon Notes: Training frig Garnishment 1 THIS ALL Federal FICA u State Vacation Health 3 S 0.00 4.00 4.W 0.00 0.00 000 0.00 8.00 $53.S1 PROJECT PROJECTS Tax Medics* Tax set Holiday Waftfe Pension COWAN.TH0141A5 I 12650CPLUMBER I $295.00 $144A2 $111.76 $20.76 50.00 $0,00 $0.00 1 UNDERGROU Shenandoah Road Q ND UTILITY O 0.00 2-00 2.0C 190 0.00 0.00 0.00 4.00 570.87 $9T7.93 D10 58t39 PTPEFITTEP $712-36 $1,9UT03 Training Fr1rQe Dues Trovel8 Save Other Total Fringes Sub Oeduci 1 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 $0.30 $4.80 50.00 $0.0D $0.00 $0.00 M-16 $929-10 Other DeducWn Notes: Trairlino fee- Garnishrnegl 5 = STRAIGHT TIME -OTHER -Any omiw detlicbons, contributions and or pByrnenls whether or not mcivoed or requrod by oft vailing wdye delermmatiom must be separau* WWI- CERTIFICATION I.= be wmplaicd 0 = OVERTIME Use exUa shecl(s) if nnMsssry_ (See reverse silo] Form A-1-131 {New Z-X1 ❑ = DOUBLETIME SO = STATE OISA91LI7Y INSURANCE cinDepur Departartmeent of 2024 Herbert Walkup Pipe line Replacement 1 Herbert Walkup Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page? of s (1) (2y i (3j (4) DAY (5) ,6) 7y (8) 1 l�3 I S I M I T I W I T I F I S NAtiME.ADURE55 n WORK S_l Date NET SECUDYNUMBER oiaSOCLAL £� IFICATION 7114 17115 17116 17117 1711S 17119 17rrA T�]M HUMS YHLIRL OF PAY GROSS AMOUNT EARNED WAGES CHECK DEDUCTIONS. CONTRIBUTIONS AND PAYMENTS PAID OF EMPLOYEE i N FOR O. Hours Worked Each Day WEEK S 0,00 0-DO 0.00 0.00 8.06 0-DO 0.00 8.00 S53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA$ State SDI Vacation �b$r Pension I Medicare Tax Holiday Welfare PLUMBER/ I S273-00 611 Gl=n ock 811 Glenlxaolc Drive 3 UNDERGROU $2D420 S182.56 $29.w g0.p0 $0-00 50.00 ND UTILITY O U.i10 0.00 O.Ol7 0.00 2.00 Q,00 0.00 2.00 S70.87 S1:9BR,1$ DID PIPEFITTER $570-62 $2.673.92 Training Adrr►in I Dues Travel& Savings 01her TOW Frnges Sub Deduct_ 0.00 0.00 0,00 0,00 0.00 0.00 0.00 0,00 SO.OR J Ill I $4.00 S0.00 $0.00 S0.00 50,QR $4.60I $693.74 Other Deduction Nolen! Trainl!kgfgg S 0.00 8.00 8.00 8.00 8-00 0.00I 0-00 32-00 S53-61 rederal PROJECT PROJECTS Tax I NUA 8 Medicare 5Aate SDI Vacation Health & Pension I j Tax Holiday Wet`are GIRARDiN, FLOYD PLUMBER I I P. O. Box 102 River UNDERGROU 542i.00 $1981 518D.78 $28.51 SZ1.00 $p,Op $0.00 �+ I I ND UTILITY 0 G.00 2.00 2.00 2.0D 2.00 0.00 0.00 $.00 $7Q-137 SI-78362 D1D PIPEFITTER I - - $2.282-48 $2.610.02 Training Adndn 1 Dues Travel & Savings Total Other Fringes Sub Deduct I ❑ AAO 0.00 O.OQ 0.0R 0.00 0.000EI O 0.00 O $0.00 I $16.DO $0-00 $0-00 W-00 SO.00 $17.80 $846-40 Other Dedudidn Notes; Training fa I S 0,00 8.00 8.0D 8A0 3.00 0-00 0.00 32,00 $53,61 THIS ALL Federal PRWECT PROJECTS Tax FICA & Medicare State Tax SDI Vacation Holiday Health & Pennon Welfare GRIEGO, DAVID I 1730 Rods Springs Road Escondido GA PLUMBERI I UNDERGROU 5410-OG $194.95 $179.34 328.03 50.00 $0-00 50.00 0 I ND UTILITY O 0,00 Z00 2.00 2.00 2.00 0.00 0.00 8-00 S70.87 S1,736.04 DfD PIPEFITTER 32,282.48 $2,665.96 Training Admin 1 Dues Travel S Savings Other Total Fringes Sub Deduct D 0.00 0.00 0.00 0.00 ADO 0.00 0.00 0.00 $0.00 315_0O S0.00 $0.00 50.00 50.00 $17.60 $829.92 Other Deduclon Notes: T utr� S 0.00 8.00 8.00 8.00 8.00 800 0.00 40.00 553.61 THIS ALL Federal PR04ECT PROJECTS Tax FICA $ Medicare state Tax 50f Vacation Health & PPensionr MERCIER. ' Holiday Welfare B ,I PLUMBER I $461,DO 4D0 CragmonF Court 0Grag UNDERGROU $214.04 S201.82 W-77 $0.00 $0.00 S0.00 Cameron Park CA f I ND UT1LI1']' O 0-00 1.50 2-00 2.00 1.50 0.00 0.00 T.00 S70.87 S1 690-24 D1❑ PIPEFITTER $2,640.49 $2.817_6T Training Dues Travel 8 Savings Other Tolal Fringes Sub Deduct. I I7 #_R0 0.00 O.t7t] 0.00 0.00 0,00 O.QR 0.40 $0.00 I $18.00 $100 $0.00 S0.00 S0-00 $19.80 $927 43 Other Deductlarr Notes: Training fee S = STRWGHT TIME m OVERTIMEquired -OTHER - Any other rleduc ws. contnbubons arrriln paymenrs whamef or not included or reby prevailing wage detemiinalaxrs nursl be wparesey 6srcd- CERTiFICATIL`hF;�S.i 6a nxnpleto6 FOrrn +4i-131 (New 2-f1) 0 = � �ME USe axua shecas) it ��ary, (See rye side) SOi =STATE OISA&CITY INSU RRHCE 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline ll Department of 4do""California industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page Iof6 (1 ) (2) I (3) ;4) DAY (8) (9) SIM I TIWITIFIs NET NAVE, ADDRESS ? WAGES AND SOCIAL to -wow Hate 707AL HOURL Y RATE GROSS AMOUNT DEDLJGTIpNS. CONTRIBUTIONS AND PAYMENTS CHECK NO- SECURI7 Y NUMBER ri r iFICATION 7114 1 7115 1 7116 1 7117 1 71118 1 7119 17rA "OURS OF PAY EARNED FOR OF EMPLOYEE ' WEEK Ho:n Worked Each Day I THIS ALL Federal FICA 8 State SDI Vacation Health & Pension 5 DAD 8.00 8.00 9.00 B-00 0.00 0.00 32.00 S53-61 PROJECT PROJECTS Tax Medicare Tax HoWay Welfare PASTEN VFLASQUEZ- I PLUMBER/ $138.00 $113-35 $141.37 $24.93I $0.00 $0,00 SO-00 ELISI❑ 0 (UNDERGROU ❑ D.00 i.50 2.00 1.50 1.50 0.00 0.D01 6.50 $70.87 $1,788.80 DM 742 Rolm Dr �95770 ND L FILITY I PIPEFITTER - - $2,176.18 $2.282.¢8 Traini ng Adrrrin 1 Fringes Dues Travel& Sub Savoys Other Total Deduct, D 0.00 0.00 DAD 0.00 OJW 0.00 0.00 0.00 $0-00 $15.40 SO 00 $0.00 SO.00 S0.00 $15.130 $493.68 Other (?eduction Notes, Training i „rj ALL reaeral fR A & $tale SDI Vacation Health & Pension S 0.00 8.00 8.00 8-00 8.00 0- 0 0.00 32-00 S60.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare PEREZ, SERGIO I PLUM13ER 1 5430.00 $194,89 S176.22 S28-OS SO-00 $000 SO-00 149 Oak Ridge Drive UNDERGROU 7 O D_p0 1.50 2.OD 1.5D 1.50 O.flO 0.00 $.SA WAS $1 71$.46 DID lone CA ' NO UTILITY I PIPEFITTER $2.442.93 $i2,W.60 Training Adroln 1 Erinyes Dues Travel & Sub Savings ❑then Total DeducL D D.DO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $D.DO $15.40 $0.00 $0.00 S0.00 $D-00 $16.00 $845.14 I Other Deduction "es: Training fee THIS ALL Federal FICA & State Sfll Vacatiw Health 8 Pension S 0.00 8A0 8-00 8.00 5-00 0.00 0.00 32.OD $53.61 PROJECT PRWECTS Tax Medicare Tax Holiday Welfare SARIA, MORGAN PLUMBER1 S334.DO $170-69 $148.90 $24.54 SD.00 $0.00 $0.00 1413 Rancho Way South Lake Tahoe UNDERGROU 0 '0 0.00 1.50 2.00 1.50 1.50 0.00 0.00 6,50 $70-67 51,555.12 DAD CA 961 W NO UTILITY PIPEFITTER $2,176.19 $2,247,05 Training 7 FriAdrnges FFringes hues Travel & Sub Savings Other Total Ded4cL I � D 0.00 0.00 ODD O.OD 0.00 0.00 0.00 _ 0.00 30-00 $15A0 $0.00 $0.00 $0.00 5U.00 $15.80 $691.93 Other Deductlon Notes: Training fee THIS ALL Federal FICA & State SDI Varation Health & Pension J S 0.00 8.00 8.00 8.00 S.DD 8.00 0.00 40.00 $80.00 PROJECT PROJECTS Tax Meftare Tax Holiday Welfare TAYLOR, i KRISTOPHER PLUMBER 1 - $414.DD $2d6.67 S242.42 $35.47 SO-00 $0.00 S0.00 19730 Forest View UNDERGROU 1 D O.OD 2.00 2.00 2-Op 2.00 0.0f1 0.00 8.00 $80.45 S2-285.97 Circe Pioneer CA 950% NA UTILITY , PIPEFITTER $3.D43.60 53,244.73 Traini i Admen f Frwr9es Dues Travel & Sub Savings Other Total Deduct 0 0.00 0.00 0.00 0,00 0.00 O.00 0,D0 0.00 $0.DO 51920 50.00 50.00 $0,00 $(}.DO $20.20 $958-76 Other Deducbpn Nafes_ Trainino S - STRAJGHT TIME 'OTHER -wry olner deductions. carxrbWjoM andlar psymeMs wneiber Dr A01 nduded Or requ1fM by PrevaftWA9e de' arm orations must be separately MW. L'ERTiFICATION hj=oe oomph ed Fo m 1-131 thew 2�8J 0 = ovE-.. RTIMC Use extra cheeks) if reDf _ry nr (see movee Mae) D = 5O BLETIME M = STATE ENSABir1TY INSURANCE Cal 2424 Herbert Walkup Pipeline Replacement) Herbert Wallop Pipeline Department Departure of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of 6 (4) DAY (5j (6) {7} (8j (9) SIMITIwITIFIsI NET - NAME. ADDRESS AND SOCIAL o°g J WOW( Date TOTAL HOURL Y BATE GROSS AMOUNT aSDtlGTIONS, CQNTRIBUTIOf IS Ar10 PAYMENTS WAGES CHECK PAID SECLjFzirY NUMBER 6?' X J (FICA IT ON 7114 17115 + 7116 17117 1 7118 17119 1720 HOURS OF PAY EARNED FOR ND. OF EMPLOYEE J WEEK Hos urWorked Each Day THIS ALL Federal FICA & State SDI vacation Health & Pension J s 0.00 8.00 8,00 8.00 S.00 0,00 0.00 3ZDO SN-64 PROJECT PROJECTS Tax Medicere Tax Holiday Welfare VINCIGUERR►., AUSTIN Operating $629,00 $321 A4 5342-39 $46.22 $0A0 30.00 SO-00 ,V, Bodega Court EI (H Sneer 2 f (Heavy 8 O 0.00 2.00 2.00 2.00 2.00 O.flO 0.00 8.OD 'S132.7 52,862.71 ❑I❑ Dorado Hips CA Highway work} 1 - 1 ;4,250.15 :4,250.16 Training Adis g Fringes Dues Travel ,& Sub Total Savings Other Deduct. J Group 3 Area 1 ' - D 0.00 0.00 0.00i 0.00 0.00 0.00 ODO O.00 $0.00 $da.dc] 50.00 $0.00 $0.00 $1,387.4 $0.00 $45,40 5 -- Other Deduction Notes: Training Fee -pR.l- -i-eoerat RCA & Stale -- --- SUI vacation Health & T Pension 5 0.0o 8.00 8.00 8.00 6.00 0.00 0.00 32.00 $W64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare VINCIGUERRA. CASEY J cpeaating 5477.00 $28120 $282.49 :+10.44 $0.00 S0.00 S0.00 470 Broadmeadows J Engineer d {Heavy 8 D 0-00 0.04 0.04 2.00 2.0D O.I74 0-00 4.00 $132.7 OvD Court Sutler Greek Highway 3Area}7 � Group 3 Area 1 1 j3.719.32 53,710.32 Training A&Tfl$2,371.47 FnrrOes Dues Travels Sairrgs Other TOW Deduct. E p 0,00 0A0 0.00 0,00 0.00 0.00 0.D0 0.00 WDO $43.56 WDO S0.00 SO -CO SO-00 $266.72 31,347-8 5 Other Deduction Notes: Training [g Cal Savers 1 THIS ALL redefal FICA 8 State S01 Vacation Health 8 Perrion S 0.00 &.00 8-00 a.00 8.00 0.00 0.00 32.00 553-61 PROJECT PROJECTS Tau Medicare Tax Haiday yyelTere WILLSON, SLOAN J PLLIMSEF21 'WgAD S220.05 S203.77 $31.85 $0-00 $0.00 SO.00 3D20 Newton Road. Sp, 1 PtaoeralYe CA 1 UNDERGROU 5 O 0.00 1 50 2.O1I 2.00 2.DO 0.00 4.00 7.50 574.87 - 57,836.66 DAD 1 NO UTILITY PiPEFITTER $2.247.05 S2,893.31 Training Adninf Fringes Dues Travell4 Sub TOW Savings Other Deduct ❑ 0.00 0.00 0.00 3.00 0.00 DD00 0.00 0.00 $0.00 515,80 $0.D0 $0,00 SO.00 $0,00 $132.ia 31.056.6 5 Other Deduction Notes: T�trtino fee. Gamishmenl 1 - THIS ALL Federal FICA B State SDI Vacation Health & Pension J S OAD WDO 8.00 8A0 8.00 8.{i0 0.00 46.00 S99.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare YOUNG JIA1 U J Operating 5929.00 $.41,06 S486.35 $59.22 SO00 SO -OD SO.OD P. i3ax58 J Engineer ' (Heavy & 0 0.00 2.W 2.00 2.D0 2,00 0.00 0.00 8.00 5132.7 1 S3 19a55 Oro 95629 JHighway work] 1 $5.047.28 $5,445.41 Training Admin 1 Dues Travel & Sub Savings Other Total l Group 3 Area 1 Fringes --ID O.DD 0.00 0.00 0,04 0,00 0.00 0.00 0-00 $0.00 S56.06 $0.00 $0.03 $0-00 SO.00 $388.43 S2,254.8 fi Other Ueductlan Notes. TrarmPg fee, Gal Savers S ='STRAIGHT TIME ^OTHER - Any other daduc6ons. contrii uUom ancvor peyrnents whether or W1 Odreded or required by pmvuNNng wage ¢010rrnxtallon5 rIwW be sepamiey 4sieM CERT[FICATIOtd %LU be mm pleieC O - OVERTIME Use exlra sheed(&) it rpeWmaq. (See reverse srlel Form A-1-131 (Nevi 2-W) 0 = DGUSLETIME SDt = STATE DfSA&ILITY INSURANCE Caifomia Department of 2Q24 Herbert Walkup Pipeline RepacernelTi 1 Herbert Walkup Pipeline Industrial PclaUom PUBLIC WORKS PAYROLL REPORTING FORM Page � of s (1 ) (2) 1 i31 I4)DAY (51 's1 I 3 I 5 I m I T I W I T I F� S NAME. AIDDRESS AND SOCIAL i �02 WORT{ Date HOURL NET SECURITY NUMBER a- _ CLASS— IFICATlON 7114 7115I71f6I7117 711$ 7f19I7120 TOTAL Y RATE GROSS AMDUNT EARNED WAGES DEDUCTIONS . CONTRIBUTIONS AND PAYMENTS PAID CHECK OF EMPLOYEE #X i OF PAY FOR NO, Hours Worked Each Day WEEK SOW. 8.00 8.00 8.D0 8.00 0.00 000 32.0E $5361 THIS PROJECT ALL Federal PROJECTS Tax FICA & State SDI Medicare Tax Vacation Healm a pension Holiday Welfare ZELLERS JEREMY MAIN PLi1M6ER 1 UNDERGROU S386.00 $211.58 $196.60 $30.42 30.00 $0-00 50.00 O MOICELLlMf IIE HILL ❑ ND UTILITY O D• 1,d0 2,D4 2.00 2,04 D.Od 0,D0 7,00 570.87 PIPEFITTER $2.211,61 $2,782.23 Training Admin$ Dues Travel $1 601.33 DID Savings Oilier Ada 5 ub � D 0.00 0.00 d.017 ❑.00 000 0.00 D.00 0.00 $0.t741 -- $15.60 $0.00 $0.00 $0,00 WOO $157.40 3980-90 Oww Deduction Noes: DALu rw ire- Garrrishmoni S - STRAIGHT TIME •OTFIEIR - Any os+er deductions, c ontri wtiom andror payments whether or root included or required r" M A rater I�sle{I. CERTIFICATION MUST be cornplet" Fuan A-1-131 0 = OVERTIME Use exua shed s if neo¢�sa P ''gage delerm:�alions ny.�l he sC e { 2�y 0 = DOUSLEr1ME f J ry. 9see !averse side) SO4 = STATE DISABILITY INSURANCE 4du 121 California Department of tndustria! Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE �CONTRACTOR ISUBCONTRACTOR Vinciguerra Construction, Inc. FIRST 13AYAND DATE OF PAY PERIOD 7114=24 1 do hereby certify under penalty of perjury: 2024 Herbert. Walkup Pipeline Replacement 1 Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM page a of s CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD 7120M24 (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 lay any person other than permissible deductions. (2) That this employer has complied with the requirements of the California Labor Code Sections. 1771, 1811, and 1816 for all perforated 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 appEcable wage determination incorporated into the contract; (b) FXI Determined by the Director of Industrial Relations for the county or counties in which the worts is perforated; that the classificaton 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 pJan(s), funds(s), or programs) for the benefit of listed employee(s), except as noted below. (b) E wJ Have been paid directly to the listed employee(s). except as noted below. (c) E-1 See exceptions noted below. EXCEPTION CRAFT REMARKS: Except for Training funds for all crafts paid directly to CAC. EXPLANATION NAME (PLEASE PRINT.) TITLE Austin Vinciguerra f President j rIGPIATtJt tE: �. DATE I 812612024 On federally -funded projects, permissible deductions are defined in title a. Code of Federal Regulations, part 3, issued by the Secretary of Labor under the Copeland Act, (40 U. S. C. 276c). Also, the willful faisification of any of the above statements may subject ttie 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). 2503 ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For infonrraton call (916) 654-CA10 or TOD (916) 654-389D or write Records and Forms Management, 1120 N Street, MS-39, Sacramento, CA95814. California Department of 2024 Herbert Walkup Pipeline Replacement 1 Herber[ Walkup Pipeline kndustf41Relations PUBLIC WORKS PAYROLL REPORTING FORM Page.1of5 NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S LICENSE NO.: 358838 ADDRESS P. O. Box 157, Sutter Creek, CA, 95"51 IOR SUBCONTRACTOR: SPECIALTY LICENSE NO. - PAYROLL hla. I FOR WEEK ENDING (SELF-INSUREU CERT: PROJECT OR CONTRACT NO.: Herbert walkup Pipeline I 1B 712712024 WORKERS' COMA: PROJECT AND LOCATION: 2024 Herbert Walkup Pipeline Replacarnent, ELD � (1) (2) i (3) (4) DAY (5) (6) (7) (8) 1 NAME,AQDRESS �z I S I M I T I yy r T I F I I g AND SOCIAL i d r I WORKDate - - HBURL NET SEOF e I IFIGi CLASS- 7121 17l22 17123 17124� 7f25 7P2G + 7l27 TOTAL WF VRS RATE Yp� GROSSEARNED AMOUNT WAUEDEDUCTIONS. CONTRIBLMONS AND PAYMENTS PAIQS CHECK P p EEER 1 FOR NO. I Hours Worked Each Day WEEK I S 0.00 0.00 0.00I 0.00 4.00 0.00 0.00 4.00 S94.64 THIS ALL Federal FICA & State PROJECT PROJECTS Tax Medicare Tax SDI` Health & Pension Holiday Holiday Welfare COWAN THOMAS I Operating - 12550C I Engineer 570300 377.15 $30.62 $11.10 30,00 40.00 SD.00 Shenandoah Road 0 (Heavy & 0 IHighway 0.00 0.00 0.00 0.D0 0.00 0,00 0.00 0.00 S125.2 95669 work)1 I Group 3 Area 1 1 Adniiiin#446.73 $9T8.5$ ;1,018.48 Training Fringes Dubs Travel 5 p & DID Savings Other �uall. - - f - - - I 0 I 0.0 A o-00 a-w 0.00 0.00 a.o0 0-0a . 000 sO.aa $4.84 $0.w 30.00 Sa.DD $0,001 $345d $567.75r Other Deduction!!llNotes: Training fee. Garnishment S 0.00 D.DO 0.00 0.00 4.00 0.00 0.00 4.00 $53-61 THIS ALL Federal FICA $ i Stale SDi PROJECT PROJECTS Tax Medicare Tax Vacatitn Health & Pension COWAN,THOMAS12650 I Holiday Welfare ena C Shenandoah Road PLUMBER! I UNDERGROU 0 5103.00 577.15 530-62 $11.10 $0.00 $0.00 $0-00 putt CA 95689 1 ND UTILITY o 0.ao a -Da O.aO Q.oa 2-D0 0.00 p.OD 2-OC 570.87 - $448.73 010 PIPEFrTTER 5:7 -18 51,01fi.48 Traininiq 1 Dues Travel & Savqngs Other Total Fringes Sub Deduct. I 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $2.40 50.00 $0.0Dj $0.00 $0.00 5345.88 $567.75 Other Deduction Note3: T n S I 0,00 0,00 0.00 8.00 8.00 a.00 O.DC 24.DD S53.61 THIS ALL Federai FICA & State SI?I PROJECT PROJECTS Tax Medicare Tax Vacation Heath & Holiday Welfare pension GABREE. PAUL PLUMBER/ Ell Glerbroak Drive UNDERGROU $267.04 i201.81 $179.38 $29.02 ;0.D0 $0.00 $0.00 3 ! 0 NO UTILITY 0-00 ODD 0-00 2.00 2.00 1.00 0.00 5.00 MA7 S1,960.83 DID PI 1 PIYEFITTER $1.640.99 52,650.04 Training Admtnl Dues Travel8 Savii� chef Total Fringes Sub Deduct + 0 0.00 0.00 0.00 0-00 0.00 a_p0 n.o0 O.OD $D.oa 511.60 $0-W $0,00 $0.00 SO.01) $12.30 $689.21 Other Deduction Notes. Ira ining fee S STRAIGHT ❑ , OVERTIME -OTHER - Any other deductions cawibW ons @fKVor paymera5 +.Tether or not inducted Of naMuired by ,?MW I1 r g wage determinations musl he sepers * bs*d_ CERl1F1CA71DN MUST be completed Foon R-1-431 (New 2�D) p = DOLIBLETIME Use extra sriW(s) 9 necessary_ :'See reverse s de) StA = STATE OISAB1 "INSURANCE California Department of 2624 Herbert Walkup Pipeline Replacement lHerbert 'NaikUp Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM ~� Page 2of5 (1) (2) ; (3) (4)DAY 5) ,6j I7j 1 I SIMITIwIT�F�s NAME. ADDRESS AND L 7 ° WORK I Opine s NET SECURITY WJMBER 6 CLASS =C I IFICATION 7121 17)22 17123 ! 7r24 1 7125 1 TOTAL HOURS v BATE RATE GROSS AMOUNT EARNED WAGES DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID G OF EldP.LOYEE x W I 7126 + 7127 DF PAY FOR NO. Hoixs Worked Each Day WEEK J I S D.00 0,00 5.00 8-W B-00 6.DO 0.00' 27.00 S53.61 THIS ALL Federal PROJECT PROJECTS' Tax FICA.S Medicare State Tax 5O1 Vacation Holiday health $ Welfare Pension GIROIN,FLOYD I PLUJA$ERI P,0 . Box 102 Ricer P. ❑. B I UNDERGROIJ $293.00 $156.32 $124.63 ",48 S0.00 $0.00 SO-00 Pines CA 95675 1 J NO UTILITY ❑ Q.00 0.00 0.00 2-00 2.00 0.00 0.00 4,00 $70.87 S1 446.92 CJ❑ - I PIPEFITTER $1,730,05 32.056 75 Trairing Ad snI Dues Travel Savings Other Total Sub cL D 0.00 0.00 0.00 0.00 0.00 0.000.00 0.00 30.DO I . S12-40 $0.00 $0.00 S0,00 $0.00 $13.40 3509.83, Other Dedutdgn Notes- TnAqjM - S 0.00 0.00 8.00 8,00 0.00 4.50 0.00 20,50 S53.81 rrsls ALL Federal PROJECT PROJECTS Tax FICA & Medicare State Tax SDI Vacation holiday Health & Welfare Pensioner GRIEG❑. DAVID J 1730 Rode Springs PLVMUER 1 I UhiDEROR4U S103.00 $90A 4 S42.61 $12.96 SO-00 $0-00 SD 00 Road Esc�nddoC4 0 I ND UTILITY O 0-00 O.DO 0.00' 0.00 0-00 O.nD 0.00 0-00 S7037 920 PIPEFITTER I $1,D99.01 57,186-51 Traintrrg Admin J Dues Travel & Savings Other $929-60 DID Total Fringes gab �� I D 0.00 0.00 0.00 0.00 0.00 0-00 0-00 0.00 50.00 I $8,20 $000 $0.00 $0.130 SO-00 $8-20 $256.91 OIh6r Deducfion NDIeS: Training fee I S p.p0 O.oQ a.00 s.Qp 8.00 7.60 00 0.ROJECT 31.50 S53.61 PTHIS ALL Federal PROJECTS Tax FICA Mackare State Tax SDI Vacation. Holiday lleafth & Welfare Pension MERGER, I ❑N PLUMBER I I S303.00 400 Cr U $163,15 S133.78 $23-46 S0.00 s0-DQ SO.GO Cameron Park CA 1 o UTILROU NO UTILITY O 0.00 0.00 0.00 0.50 2-OD 0.00 0-00 2.50 $70.87 S1 509.38 CID I PIPEFITTER $7,885.90 $2,146.77 Training AdrWm l Dues Travrkqm el Savings Other F DTolal edLKJL 0 0.00 0.00 0.00 D-OD 0.00 0.00 0.00 0.00 $0-00 S13.$0 $D.DD $0.00 S0.00 SO.00 $14.00 $637-39 Other Deduction Notes: Training fce I S 0.00 0.00 0.00 3.00 8.00 5-00 0.00 21.00 S53-61 THIS ALL Federal PROJECT PROJECTS Tax FICA $ Medicare State Tax SDI Vacation holiday Health & Pension PASTEN _ Welfare VELAStUEZ, A R I I S42.00 ELISIO UNDERGROU DERG $112.38 S59-19 $16.18 $0.00 $0.00 $0-00 742 Ro 742 Bourn Dr 0 I ND UTILITY 0 0.00 0.00 0.00 0.00 2-DO O.DO 0.00 2.00 $70.87 S1,238.73 DAD 95776 I PIPEFITTER _ $1,26T55 31,478.86 Training 'domes Dues Trawl a Savings Other Su DTotal educt I ❑ 0-00 0.00 0-00 0.00 0.00 0.00 O,OD 0.00 50.00 I $9,20 $0.00 $0.00 S0.00 50.00 $9.60 $240.13 Other Deduction Notes: Training Fee S = STRAIGHT TIME 'OTHER -wry other deduams. corcibu6ons wwor payrr e s wrelner or rot induced OF Mquired by Prawa-Wg wage Oelermmatans must W separately listed. CERTIFICATION I.k_T tx cornrielr_u Form A-1-130 1 [New 2�OJ = OVERLEAF Use e#ra sheut(s) d neaessary- = OOi18i.E711tiE (see reverse side) SIN = STATE nISADIL I7Y INSURANCE California Qeparllnentoi bepa 2024 Herbert Walkup Pipeline Replacement !Herbert Walkup Pipeline kldustsiialRelations PUBLIC WORKS PAYROLL REPORTING FORM 4 Page-3 of (1) (2) {3) (4)DAY r5) `8} (7) I 1 5 I M' T I 4Y f T I F 5 HAME,ADDRESS AND SOCIAL SECURITY NUMBER o6 WORK a I d $ CLASr Dale TOTAL HOURL Y RATE GROSS AMDIJ NT NET WAGES CHECK OF EMPLOYEE IFICATION � i121 17rr2 � 7r23 17124 17125 171is 17127 HOURS OFPAY EARKrED DEDUCTIgNS. CONTRIBUTIONS AND PAYMENTS PAID NO. + FOR I Mows WgdC13d Each Day WEEK S 0.00 0.00 6.50 8,00 8.00 0,00 O.DO 22.50 S60.00 THIS ALL Federal PROJECT PROJECTS Tax FICA & Medicare State Tax SDI Vacation Holiday Health $ Welfare Pension I I PLUMl3ERl 1 $371.00 149 Oak Ridge Drive 149OaSERGRidge D UNDERGROU $176.DD $150.95 $25-30 SO.00 30.00 SO.60 ND UTILITY ❑ 0.00 ODD 0,00 1.5D 2,00 O.DO 0.00 3-50 $80.45 S7 577.37 DID 1 PIPEfITTER S1,631.58 '$2,312.42 Training Fri 9es Dues Travel Savings Other Sub DeTiAal duct. I D C.00 0.00 0.00 0-aD 0.D0 0.00 0.00 0.00 $0.00 r , $10.40 $0,00 $0.00 $D.OD $0.00 $11.40 $734.65 other Deduction Notes Tminmogr� I I - r S 0.00 4.00 0.00 D.DO 8.00 fi.00 0.00 18.00 $53.61 11-11zi ALL Federal PROJECT PROJECTS Tax FICA & Medicare Stale Tax SDI Vacation Horiday Health &SAB-- Weirare Pension In I Rancho WN Way 1413 Rancho PLUMBER I 1 UNDERGROU $116.00 W-84 $46.01 $13.64 $0.00 S0.00 $0.00 Scul LakeTahaa Q I ND UTILITY O 0OD O.UO 0.00 D.00 2.00 0.00 D-OD SOD $70-ST CAP 615D A9 I PIPEFITTER $1.100-72 $1,248.46 Training Adrnilf DUBS Travel8 Sevin � $967.17 DID Other Total Fringes Sub Deduct r D 0.00 0,00 0.00 0.40 0.00 0.00 0.00 q1� $0.00 I $8.DO $0-0o $0.00 S000 $0.00 $8.80 $261.29 Other Deduction Notes: Training Fee I S Q.00 0.00 $ 00 6.00 5-00 8.D0 0.00 32.00 $60.00 THIS ALL Federal PROJECT PROJECTS Tax FICA & Medicare State Tax $[A Vacation Holiday HeahJ* & Welfare Pension TA]'t.OR. I DPHER PLi3MSER1 1 S444.00 $257.03 19730Forest View 19730 UNDERGRgU S256.26 $39.96 SO-00 SO-00 $0.00 Cirde Pioneer CA 1 1 NO UTILITY 0 O.DO 0.00 2.DO 2.00 2-00 2.00 0-00 8.00 S80.45 $2.363 54 DID PIPEFiTTER S0.00 $3,378.19 Training Fdnges Dues T Suel& Sang' Other TOW r D 0.00 0.00 0.00 0.00 0.00 0.00 O.DO 0-00 50-00 S16-00 $0.00 SD.00 $0.D0 $O.4D ;18.40 $1.015.6 5 Other Deduction Notes: Traini S 0.00 0.00 8A0 8.00 8.00 8.00 0.00 32.00 S99.64 THIS ALL Federal PROJECT PROJECTS Tax FICA $ Medicare State Tax 5Ci Vacation lialiday Health & Pena, Welfare VINOGIfERRA UST AUSTIN j Operating 330 6adega Court Ell I Engineer 5132.7 S786.00 $372.35 5410.4$ $53.54 S0.00 $0•OD SO.00 Dorado Hits CA 2 I [Heavy & 0 0.00 O.OD 2-00 1.00 2.00 ODO 0.00 $.00 1 $3.245.01 Dip 0762 Highway work] 1 I Grow 3Area 1 P $3,552.03 $4,914.57 Training AFdringes Dues T Savings Other Total - Su0& Deduct. r I 0 0.00 0.00 0.00 0.00 0.00 4.00 0. DO 0.D0 $0.00 $44,77 $0.00 $0.04 5D.00 $D_00 $A7.19 51,689.5 6 Other Deduction Notes. Ttanigo fee U = STRAIGHT ETIME -OTHER- Any other deductions. cnrKrihu&m anWOr paymcrws wryellwr or not iiduded a required 6y preva�rrg wage determinatmm rnusl be separately tisEod CERTIFICATION! I�wsr tx oomph Y e Form A-1-131 {New 2�0} D = DOUBLETIME Use extra 5hmVs) it rKxx sary, (See reverse side,' SO' = STATE OISABRATY INSURANCE 2024 Herbert Walkup Pipeline Replacement f Nerberl Walkup Pipeline ARCalifornia Departmem of IndustrialRMations PUBLIC WORKS PAYROLL REPORTING FORM Page Iof5 (1) (2) I (3} (4,, DAY ..5i 6i (8) (g3 T I F I 8 NET NAME. ADDRESS AND SOCIAL H `06 F WORK 6 a CLASS- Date TOTAL H01JRL Y RATE GROSS AMOUNT DEDIJGTIONS. CONTRIBUTIONS AND PAYMENTS WAGES CHECK PAID NO. SECURITY NUMBER ` , ( IFICALTION 7121 17122 l 7123 1 7124 1 7Y25 1 1126 1 7127 Of PAYED FOR OF EMPLOYEE � � WEEK �I Hours Worked Each Day THIS ALL Federal FICA & State SDI VacaDOn Health $r Pension I S 0.00 0.00 6.00 8.00 8.00 8.00 0.00 30.00 $99.64 PROJECT PROJECTS Tax Medicare Tax Holiiiay Welfare VINCIGUERRA, CASEY Operating $462.00 $27-620 $275-80 $39.71 $0.00 $OAO 50.00 470 Broadmeadows Engineer 4 I (Heavy & O 0,00 0,00 Q.OD 2.00 2.00 0.00 O-W 4-00 5132,7 $2:556,69 DID Court Salter Creek Highway work) I 1 $3,520.04 $3,652.75 Training Admtn i Fringes Dues Travel & Sub Total Savings C>ttier Deduct � Group 3 Area 1 0 0.00 0.00 0.00 0.00 0.00 ODD 0.DO 0.DC $0.00 341.14 SO00 $0.00 $0_Do $0.00 $42.35 S%096.0 6 Other Deduction Notes: Train no_fce l rrrta ALL Ledefal FICA & State SDI Vacarior Health & Pension S 0-DO 0-90 7,00 8.00 8A0 0.00 O.DO 23-DO 599-64 PROJECT PROJECTS Tax Medicare Tax +-Miday Welfare YOUNG JIM I Operating SSW% $270.44 S277.24 53.8-89 SO-o0 $0,00 $O.W P. Q. 8flx 58 P. Q. FJtgmeer 1 (Heavy & O 0-00 0.00 0.00roin S132-7 $2.234,41 DID to A 96629 Highway wl rlt)1 $2.822.55 $3,569.65 Training I Dues Travel & Total Savings Other Group 3 Area 1 Fringes Sub D Deduct. D 0.00 0.00 0-00 0.00 0.00 0.00 O.DO 0-00 $0-00 $32.67 $000 $0.00 5R00 SO.00 $246.67 81,335.2 4 Dither deduction Notes: Training fee. Cal Savers I THIS ALL Federal FICA & State SDI Vacation }fealth & Pensi on S 0.00 OAO o.00 6.00 8.00 5.00 0.00 19.00 $53,61 PROJECT PROJECTS Tax Medicare Tax Hoiiday Welfare ZELLERS JEREMY PLUMBER I $6.00 $77.34 $24,70 $11.12 $0.00 $0,00 SD.OD 0194 MAIN 57 MOKELUMINE HILL J UNDERGROU 0 fl 0.fl0 0,00 0.00 Q.OQ 0.00 OJ 0 0.00 0.00 S70.87 $750.82 DiD I ND UTILITY PIPt=FITTER $1,018.59 $1.01$.59 Training n> n 1 AdFringes Dues Travel & 8BabSavings Other Tote! 4educL D 0.00 0 00 0.00 0.00 0.00 0.00 0.00 000 $0.00 $7.60 50.00 $0.00 $0.00 50.00 $148 fi0 5267.78 Other Deduction Notes: Trainim fee. Garrvshmeni S = STPAC-+rr TIME 'OTHER - any other deduci.One, conlnbmom andrar payments wfttrrer ur not included or required by preva*ifgwaga d8WMina1wns Musa ne separately iis9Ctl. CERTIr CA7104 MUST be completed 0- OVERTIME use extra shcegs) if necessary sa {See revarside] Farm A-1-131 (New Z- W) ID= VVIBLETIME 8171 =STATE MA91LfrY INSURAr4CE JWNCalifornia Department of Industrial Relations STATE OF CALIFORN[A STATEMENT OF COMPLIANCE CONTRACTORISUSCONTRACTOR Vinciguerra Construction, Inc. FIRST DAY AND DATE OF PAY PERIOD 7l2112624 t do hereby certify under penalty of perjury, 2024 Herbert Walkup Pipeline Replacement/ Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM page 5of5 CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD 712712024 (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-xefenenced 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 eamed by any person other than permisslNe 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 tha 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) U Specified in the applicabJe wage determination incorporated into the contract; (b) Determined by the Director of Industrial Re lations 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 pa id to the approved plan(s), funds(s), or program(s) for the benefit of Jisted employee{s), except as noted below, (b) r7l Have been paid directly to the listed employee(s), except as noted below. M E-1 See exceptions noted below. EXCEPTION CRAFT REMARKS: Except for Training funds for all crafts paid directly to CAC. EXPLANATION 'NAME (PLEASE PRINT.) TITLE Austin Vinciguerra President SIGNATURE: I J� DATE y/IF ' 812612024 �On federally -funded projects, permissible deductions are defined in title 29, Code of Federal Regulations, part 3, issued by the Secretary of Labor under the Copeland Act: (40 U. S. C. 276c). Also, the willful falsfication 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). ADA Notice For individuals with sensory disabilities, this document fs available in alternate formats. For informatf on call (916) 654-rA10 or TDD (916) 654-3$80 or write Records and Forms GEM2503 Management, 1120 N Street, MS-89, Sacramento, CA 95814. JOSI Department Department of 2024 Herbert Walkup Pipeline Replacement ! Mer6ert Walkup Pipeline k►dustrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of 5 NAME OF CONTRACTOR: Vinciguerra Construction, Inc. OR SUBCONTRACTOR: CONTRACTOR'S LICENSE NO- 35MM ADDRESS: P. 0. Box f57, Sutter Creek. CA. 9561 SPECIALTY LICENSE NO.: t PAYROLL NO. FOR WEEK ENDING SELF�NSURED (WORKERS CERT PROJECT OR CONTRACT NO.: Hebert Walkup Pipeline 17 COMP: IPROJECTAND LOCATION: 2024Herhert Walkup Pipeline Replacement, ELp (3) (4) DAY (5) (8) S7) (6) I i9l S I M I T I W I T I F I S I NAME. ADDRESS I� � NET AND SOCIAL SECURITYNUMBER o` r CL� g Date TOTAL TOTAL HOJRl. YOFRAPTAEVEARNED GROSS AMOUNT QEDUCT{ONS. C4hITRI$LITIONS WAGES CHECK AND PAYMENTS PAID EMPLOYEE i IFICATION 712a 1 7129 1 7130 17137 1 8f01 1 W02 1 8J03 N FOR O. Hours Worked Each Day WEEK j 5 0.00 4.00 4,00 4.00 4.00 4.00 0.00 20.00 $94.64 THIS ALL Federal PROJECT PROJECTS Tax FICA & Stale Medicare Tax SDI Vacation Health & Pension Holiday Welfare COWAN. THOMAS Operating 1265DC Engineer $622.00 $307,91 $330.41 $44.27 SO.00 $000 30.00 Shenandoah Road 0 �H. (Heavy& O 0.00 0-00 0.00 0.00 0.00 0.00 0.00 0.00 $125.2 I fir' � 1 CxauF3Pisa }1 - - - =frefILOU S4,tt63.4R Training AdrwQ Dues Travel Sa'�s Other Fnne:s Sub& Ded ct- ---_j -- - D 0-00 OX -M � O.t}Q 0.00 0.00 -U.t70 SOf10 324.ZU' - SOAR S0.00 $0.U0 SO.00 $376-24 5i,8f30.8 3 Other Deduction Notes: Training fee. CIMishment 1 S 0-00 4.00 4.00 4.00 4.00 4.00 0-00 20.00 $53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA & Medicarei Stale SDI Tax Vacation Heatth & Pension Holiday Welfare GDWAN, THOMAS12650 PLUME3feR 7 5822-DD Shenandoah Shenandoah Road UNDERGROLJ 0 O 0.00 $307.91 S330.41 $44.27 $0.00 $O.Dn S0.0D E NO UTILITY 2-00 2-00 2.0p 2.00 2.00 O.QO t0.D0 570,87 52.182.86 O!D I PIPEFITTER $1,780-90 $4.063-49 Training AdrrUn! Dues Travel & Sa s Other Total FrinBeS Soh fleducL D I 0.00 0.00 0.00 0.00 0.00 0.00 O.DO 0.00 50.00 512-00 50.00 $0.00 $4J7o 50.00 537fi.24 51.88A.8 3 Other Deduction Notes. Training_ fee GaLrishmam f S 0.00 o.q0 0.00 6,00 0.00 6.00 0.00 16.00 $53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA & State Medicare Tex SDI Vacation Health & Holiday Welfare pension PAUL G11 I PLUf BERJ � S189-DO Glen 5f 1 Glentxodk Drive L1NDt=RGROU RGRO $16924 $135.a3 $24334 50.00 $0.00 SO.00 3 NO UTILITY O 0OO 0.00 0-00 2.00 0.00 2.00 0-00 4.30 S70-87 $1 693.95 DfD PIPEFITTER $1,141-24 $2.221.16 Training Ad Dues Travel & Sayings Other Total 5 D 0.00 0.00 0,00 0-00 UM O.00 0.D0 0.00 $O.OD J $8.00 50.00 WOO $0.00 $0.00 $8.80 S527.21 Other DeduGior Notes. S = STRAIGHT TIME OT iER _pny other deduct ors. canlribul orrs and r p Form Fr1-131 (New 2-80) D z Dey-nerxs wrre9w or rlel frduded or required by pnevR*V wsge delerminaik ns musl tx: separately ksled. CF FrnF{CATM M VgT be wmpletei 0 = DOl1lURLeTl ME Lhe extra shcaKs) in rAxxwary. (See reverse sidei SDI = STATE DISADJUTY INSURANCE California 2624 Herbert Walkup Pipeline Wacerreent f Herbert Walkup Pipeline 1 department of l Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2 of � t1} (2) 1 (3) {4; DAY (5) f6i I SIMITIWITIFISNET NAME, ADDRESS AND SOCIAL 3 o° WORK Date TOTAL HOURL V RATE GROSS AMOUNT DEDtJCTIIPNS, CONTRIBUTIONS AND PAYMENTS WAGES CHECK PAID SECURITY NUMBER SECURITY a CLASS- IFICATION 7128 1 7129 1 7130 17131 I W01 I aw 18703 HOu' OF PAY EARNED FOR NO- EMPLOYEI= WEEK � HpWS Worked EachDay THIS ALL Federal FICA 8 State SDI Va,41d.y Heallh & Pension 5 0.00 S-oo $.04 8.00 8.00 8-00 0,00 40.OD $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare I GARIR4DI I PLUMBER 1 $0-00 $281,17 $0.00 S37.55 $0-00 $0.00 50.w ANTHONY P. O- Box 985 Sutter UNDERGROU 0 d 0-00 2,0q 2.00 2,00 2-00 2.00 0.00 i0.00 570-87 - $3,115-39 DID �5 i NO UTILITY PIPEFITTER - -- P.853.10 43,437,31 Training Adman 1 Fringes Dues Travel& Sub Savings Other Total Deduct 1 ❑ 0.00 0:06 0.00 0.00 0,00 0-i00 0.06 0.00 50.00 520.00 $0.00 $0.00 $0.00 50-00 $23.20 $321.92 Outer Deduction Notes: Training fee ALL reaeral FICAa Ulm - SDI Vacation Healh&-- Pension --- S ODD 8.00 $.00 SAO &00 8.00 0.00 40.00 $,+""1 PROJECT PROJEC 8 Tax Medicare Tax Holiday Welfare GIRARDIN. FLOYD PLUMBERI $694A0 $285.38 S297.23 $41.03 $0.00 $0-00 $0.00 P. 0. Box 102 River UNDERGROU 1 O (1.00 2.{10 2.OQ 2.00 2.00 2.00 0.00 30.00 $71J•67 S2.412"85 DOD Pines CA 95675 NO UTILITY PIPEFITTER I $2.853.14r $3,755.29 Training Adrnin J Fringes Dues Travel & Sub Savings Other Total Deduct d 0.00 0-ou 0.00 0.00 0.00 0.00 0.00 0.00 $0, D S20.00 $0.00 $0.00 S0.00 $0.00 $24.80 S1,34P.4 4 _ Olher Deduclinn Niobw T�Et TFil$ ALL Federal FICA & State 501 Vacation Health & Pension S 0.00 8.0o 8.00 8,00 &00 8.00 000 40.00 $53.61 PROJECT PROJECTS Tax Medicare Tax Holday Welfare MERCIER, BRANDON + PtUMSER! - 5495A0 $224,83 $216.24 $32-33 50.00 $0.00 $0.00. 400 Cragmont Court [UNDERGROU 1 O 0,00 2.D0 2.00 200 2AO 1-00 0.00 9.00 $70.87 S1,970.41 DM Cameron Park CA NO LrHUTX PIPEFITTER f 52-782.23 $2,959.d7 Training F Frirnge1s g Dues Sub Travel& � Dil'er Tatar Deduct I D 0.00 0.00 OJIO ODD 0.00 0A0 0.00 0.00 $0.00 S19.60 $0.00 $0.00 $0.00 50.00 $20.60 $989.00 I _ Other Dedudran Nolen: ironing This ALL Federal FICA 8 State Sol Vacation Health & Pension I S 0,00 8-00 8.00 8-00 8.00 5.00 0.00 40.00 S53.61 PROJECT PROJECTS Tax Medicare Tate Holiday Weifare PASTEN VELASQUEZ, I PLUMBER( $347.00 $249.74 $242.47 $35.91 $0,00 $0.00 SO-00 ELISIO I UNDERGROU 0 Q 0.00 2.00 i.50 2.00 2.00 2.00 0.00 9.50 $70.87 S2.388.43 DID 742 Bg11rn Or Wood n 95T76 j NO UTILITY F PIPEFITTER $2.617-67 $3,286-95 Training Adman 1 Fringes Dues Travel $, Sub SavingB Other ToieJ Deduct. ❑ 0.00 0-00 0.00 000 0,00 0.00 0.00 0.00 $0.00 $19.80 $fi.40 $0.00 SOAO SO-00 $22 40 $698.52 Cfter Deduction Notes: Tr S - STRAIGHT TIME 'OTHER -Arty 0Mr deduaOns. contnbu iam answ payments wheaw or nor Muded (X reajred by prevsHiog wage deierminetion5 must be Separately Iisled. CERTIFICATION MIJST w oamplered 0 = OVERTIME use extra 1540095) If Flee IrY. tsIb6 reverse sole) Form A-1-131 (New 2-M1 D = DGUeLET1ME SDI = STATE 01SA81l1TY 1NSU RA NCE California 2024 Herbert %'Vakup Pipe fine Replacernent I Herberl Walkup Pipeline Department of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of 5 (1] (2) i (3) (4)DAY ?5} of - (8) (8) S I M I T I W I T I F I S NET NAME. ADDRESS AND SOCIAL 'm $ I I WORT( hate TOTAL FIGURE TE GROSSAMOUNT WAGES CHECK DEDUCTIONS, f,gi�T1i18LtTIC1f5 AND PAYMENTS PAID SECURITY NUMBER 61; I i CLASS 7128 1 7129 1 7130 1 7131 1 8161 I IV02 8f03 �� OF PA EARNED ryC OF EMPLOYEE 3 x W WEEK I Hours Worked Each Day I THIS ALL Federal FICA 8 Stale 5fll Vacation Health & Pertision j S 0.00 8,00 8.00 8.0a 3.00 8.00 0,00 40.00 SW -OD PROJECT PROJECTS Tax tAedrear0 Tax Holiday Welfare PERU SERGIO I PLUM13ERI S754.00 $29801 $314.12 $42,85 $0.00 $0.00 50.00 149 Oak Ridg a Drive 1 ( UNDERGROU O O.t70 2,00 2.00 2,00 2,00 2.00 0 00 10.00 560,58 $2.486.62 DID 0 I ND UTILITY I PIPEFITTER -_ $3,205.80 $24919.00 Training Admin 1 Fringes Oven Travel8 Sub Savings Total Other Deduct, I D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $20-DO S0.00 $A.00 $O,W 1 $0,00 523-40 $1,432.8 S - Other Deduction Notes? Training Fee - i-eoerai -MGA6 blate , SDI Vacation - Heapli$pension S 0.00 8.00 8.oD 8.00 8.00 8.00 0.00 40.00 $0.81 PRCUECT PROJECTS Tax Meckwe Tax Holiday Welfare SABIFL MORGAN I PLUMSM 1 $0-00 $249.73 .f0.00 435.91 SO.DO $0,00 $0.00 1413 Rancl o Way South Lake Tahoe 0 I UNOERGROU O 0-Da 2.00 1.50 2.40 2•p0 2.00 O.f10 9.50 570.87Total S2.978.91 Olt) ( NO UTILITY PIPEFITTER , $2.61T67 $3,286-95 Training F°n11 g� Dues T Sub mvell& Savings Other Deduct. D 0.00 0.00 ODD 0.00 0-00 0.00 O.DO 0-00 $0.00 519,30 $000 $0.00 50.00 SOAO $22.40 $305.04 Other Deduction Notes• Tranina Tee 1 THI$ ALL Federal FICA & State SDI Vacation Health & Pension I S 0:00 a.Oa 8.00 8.00 S.W 8+00 0-00 40,00 $60.00 PROJECT PROJECTS i Tax Medicare Tax Holiday Welfare TAYLOR, KRISTOPHER I PLUMaER 1 S762.00 $364.86 S400 46 $52.46 $0-DO $0,00 SO -DO 19730 Forest Mew 1 I UNDERGROU O 0.00 2,00 2.00 2,00 2.00 2.00 0.(10 10.00 580,58 S3.163.65 DID Circe pioneer CA I ND UTILITY PIPEF[1TEti $3.205.80 $4,798.43 Training Admin! Fringes fuss Travel & Sub Savings Total Other Deduct, D 0.00 0.00 0.00 ODD 0.00 0.00 0.00 0.00 30-00 S20.00 53-00' $0.00 SO.0D $0.00 $27 00 51,6067 Other Deductron Notes: Traini - THIS ALL Federal FICA & State SDI Vacation Health & Pension S 0.00 8.00 8.00 4900 8.00 8.00 0.00 40.00 $99Z4 PROJECT PROJECTS 'fax Medicare Tax Holktay Welfare VINCIGUF-PRA. AUSTIN I Operating 51 099.0 $47222 $544.02 $67 9D 50-00 $0.04 50.00 330 Bodega Court 02 Engineer I (Heavy 8 O 0.00 2.00 2.00 2.00 2.00 2.00 0.00 10-GO 5132.7 t 0 S3.989.56 DID Odra& HiN* CA Highway work)1 S5.312.70 $6,241.67 Training Admin 1 Fringes Dues Travel & Sub Sa�mgs Total Other Deduct Group 3 Area 1 ❑ 0.00 G-W 0.00 0_00 0•00- 0.00 0.00 0.00 $0.00 S60.50 $0,00 E0.00 50.00 $0.00 SM-97 $2.252.1 Other Deduction NWes: Training fee S = STRAIGHT TIME 'MFR--Any other gem CLons eont IWUDm andror payments whether or bat indWed or rew-reO by pravai" wage deierTrIM(ions roust W SeOrmlOr I1!S*d. CERTIFICATM Ad= tm cum pleW O = OVEFM ME Qse extra Snooks) it necessary. (See reverse sde) Fow A-1-131 (New 2-90) D o DOURL"Mr: SDf = STATE DISABILITY INSURANCE California 21724 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline Department of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4of (1) J2j l (3) (4) UAY [5} 61 (7; (8j - - (9) S MIT(WITIIFI5 NET NAME. ADDRESS AND 80C1AL ! WORK o ! Date TOTAL HOURt v �� GROSS AMOUNT DED�TIONS, CONTRIBUTIONS AND PAYMENTS WAGES GK PAID CHECK SECURITY NUMBER z° � � ! I M CLASS- 7120 17M 1 7M 17r31 I SI01 1 =2 I S&I HoURS OF PAY � RNED FOR OF EMPLOYEE x ui WEEK Hours Worked Each Day THIS ALL Federal FICA & State SDI Vacation Health & Pension ! S 0.00 D.00 0.00 8.00 8.00 800 0.00 24-00 $99-64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare VINCIGUERRA. CASEY ! Operadng S685.00 5352.98 $378.48 $50.76 SO.00 �D.00 50.00 470Bmadnrwodows Engineer 4 (Hea! 9 +ry 8 O 2.1.00 0.00 0,04 0.00 2.00 00 O.vO 5.00 5132. 52.870.00 DI[] court Sutler Creek �Higmay work? 1 1 j3.054.81 'j4.649.75 Training Admire 1 Fringes Dues Travel $ Sub Total Savings Other Deduct ! Group 3 Area ! D 0.00 0.00 0.00 0.00 0.00 0-00 O-W 0-00 $0-00 r,,M.09 SO.00 $0.DO $0.00 $0.00 S311.93 $1,779A Other Dedue ion Notes Train inn fee. Cal Sayers -xLL reuerai rit is slate Vacation Heai►n -- Perrslnn - - _- SDI - ! --- S 0,00 8.00 B.DD 8.00 8.00 &OD 0.00 40.0D $W-641i PFZOUECT PROJECTS Tax Medicare Tax Hdday Welfare YOUNG, JIM ! Operating - $1,198 4 0 S497 39 $580.74 $71.52 $0.00 $0 80 $0.00 P. O. Box 58 Engineer 1 (Heavy 8 o o-oD 2.00 2.00 2.00 2.QQ 2.00 o.DO 10.flD 5132_' - 53.75 9.Sfl l7JD 96829 ( H!"ay Work)1 $5,312.70 K573.23 Training Admin I Fringes Dues Travel 8 Suh Total Savings +timer Dadra. i Group 3 Araa 1 - ! ! D 0.00 OOD 0.00 0-00 0.00 0.DO 0.00 0.00 SO -DO $W.5A $100 $0-00 50A0 SO-00 $465,78 S2.813.4 3 Other DeducUon Notes. Training Fee. Cal Savers S = STRAIGV.T TIME 'OTHER- Any Wren deductiars. CCrAnbubAnS araw power is wimtAer or rrat 6*1ded or renared by prevatlig wage detcrminalou rase be se➢ mlely listed. CERTIFICATION MUST 0e rnnrakrtod a = aVrtRTtnle use tram shaet(s) d necassarr- (See r&mrse side) Form A-1-131 (New 2-W) D , DOURLE)lME Sol = STATE DISAMUTY INSURANCE California Department or Industrial Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOR f SU BCQN TRACTOR Vinciguerra Construction, Inc. FIRST DAY AND BATE OF PAY PERIOD 7l2812D24 I do hereby oertify under penalty of perjury_ 2024 Herbert Walkup Pipeline Replacerrmentf Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM Page 5of5 •CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD 84312024 (1) That I pay or supervise payment to employees of the abova-feferenced contractor on the above -referenced contract. IUl persons employed an said project for the aboveferenced 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 ttee classifications set forth therein for each trade rate conform with the work performed. (3) That any payrolls otherwise under this control required to be submflted for the above period are oorrect and complete. Ihat the wage rates for laborers or mechanics contained therein are not less that the applicable wages rates: (a)= Specified in the applicabfe wage determination incorporated into the contract (b) 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 roistered 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 programs) for the benefit of listed employee(s), except as noted below. (b) 0 Have been paid directly to the listed employee(s), except as noted below. (c) © See exceptions noted below. EXCEPTION CRAFT REMARK& Except for Training funds for all crafts paint directly to CAC. EXPLANATION NAME (PLEASE PRINT.) TITLE AWSTiiI raM1G� gym- Fre_s'-J0'-i-f— SfGNATURE: I DATE tj 911712024 On federallyfunded projects, permissible deductions are defined in title 29. Code of Federal Regulations, part 3, issued by the Secretary of Labor under the Copeland Act, (44 U. S. C. 27$c}. Also, the willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (See section 1OD1 of tide 1 B and section 3729 of title 31 of the United States Code). ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (9iti} 654�34iD ar TD❑ (916) 654-388D or write Records and Forms carp z5as Management, 1120 N Street, MS-89, Sacramento, CA 95814, California 2024 Herbert Walkup Pipeline Replacement 1 Harbert Walkup Pipeline DeUartment of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Pagel of 6 I NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S LICENSE NO-: 358835 ADDRESS P. 0. Box 157, Sutter Creek, CA, 9W85 OR SUBCONTRACTOR: SPECIALTY LJCENSE NO.: PAYRDLL NO- FOR WEEK ENDING SELF -INSURED CERT. YROJT OR CONTRACT NO.. Herbert Walkup Pipeline EC 1$ 8MOM24 'NORKERS' COMP: I �PROJECTAND LOCATION' 2024 Herbert Walkup Pipeline Replacement, ELD {1j (2) I (3) (4) DAY (7) (8) (9) 1 'l $ 1 M I T I W I T I F I S NET NAME, ADDRESS AND SOCIAL 221 1NOO CORK Date _ TOTAL 1 OURL v RATE GROSS AMOUNT DEDUCTIONS, WAGES CHECK CONTRIBUTIONS AND PAYMENTS PAJD SECURITY NUMBER 13 LASS- iz IFICATION 8104 I Sff}5 18106 18107 + 8lD8 I elO9 I Sf10 eft' aF PAY EARNED NO FOR OF EMPLOYEE WEEK � HoWorked Each bay , THIS ALL i Federal FICA& State SDI Vacation Health& Pension I S D.00 0 Uo 8,00 800 8,00 8.00 0.00 32-00 $53.61 PROJECT PROJECTS Tax Medicare Teat Holiday Welfare CORREA. ERICK + PLUMBER/ $70.00 $168,00 577AD 424A4 $0.00 $0.00 $0,00 1535 Hussman Avenue Gardnervile ( VNDERGROlJ 0 0 O.OD 0.00 1.50 1.50 1,50 2.00 0.00 $.50 570.8T - 51,85&86 24Q9 Total ND UTILITY � PIPEFIT-TER - � Adrrrn 1 Training Frae }2,176.1$ ;62,271,61 Trainxrg Dues Travel & Sub 3arngs Other �� --0 00 TFAO ��B 0-D0 0.00 0.00 0.00 _ _ $0.00 - S15A0 $OAO $0.00 $0-00 $0.00 $15.60 S354-95 OIhBr Deduction Notes: Training fee 1 1 THIS ALL Federal FICA 8 State 50i Vacation Health & Perlson I S 0-00 4-00 4.00 4.00 4.00 4.00 0.00 20.00 $94-84 PROJECT PROJECTS Tax Medicare Taut Holiday Welfare COWAN, THOMAS Operatin4 $714.00 $278.93 S291.64 $40-11 SO-00 $0,00 $0-00 12660 G Shenandoah Road Engineer Q (Fleavy & ❑ IH' 0-00 D.00 0.00 0-00 OR 0.00 0-00 0.00 5125-2 1 Admin r Travel & 51 983.82 17/EI Tate! 95669 hwa J g Y work f y7.892-8i3 �882.34 training Fr. ages Dues Sub Savings Other Deduct. Group 3 Area 1 r D � 000 0-00 0.00 000 0.00 0-00 0.D0 0.00 $0.00 $24.20 SO00 $0.00 S0.00 30-00 $374.(A 51,698.2 - Other Deduction Notes: Traiwino Few Gami0mont l -- -I THIS ALL Federal FICA & State SDl Vacation Health & Pension I S 0.00 4.00 4.00 4.00 4.00 3.50 0A0 19.50 S53,61 PROJECT PR1J JECT$ Tax Medicare Tex Holiday Wavare COWAN, THOMAS I PLUMBER 1 - _ 5714.QG $278 93 S291.64 $40.11 50.00 $0 00 $0.00 12650C Stm aa1d60h Road 1 UNDERGROII 0 O 0.00 2.00 2,00 2.00 2.00 0.00 0,W $AO $70-87 51,98'_62 DID I PI UTILITY I P1PEFlTTER g1,672.38 $3.682.3d Tralntirg Adnrn Fringes Dues Travel& Sub Savings Other Total Deduct "W"'m I D 0.00 0-00 0.00 0.00 0.00 0.00 0.00 O.DQ $0.00 $11.00 $0.40 $4.00 30.00 SO.00 $374.04 S1.698.7 2 Other Deduction Motes: Trairyno fee. Garrvshmar7 S e STRAtGt l TIME -074ER - Any other deduebons, convbu(iars ar&or payments whether or rmi ndudgd or required by pmva" wage Remo mans mjs1 5e waralePl Wed. CERTIFICATION MUST he cWmplef®d O - OVERTI ME Use QWa aheOgS) if (10=6arY, (See reveftk cul Form A-1-131 {Nate 2-Ml 0 = DWSLEM!AE SDI = STATE DISABILITY INSURANCE rla 2024 Herbert Walkup Pipeline Replacement! Herber! Walkup Pipeline Department of Depa4 lndustrialReWons PUBLIC WORKS PAYROLL REPORTING FORM Page 2of {11 1 (3) (4) DAY (5j i:fi_ i!: W (9) I SIM.ITIWITIFIS NET NAME. AQORESS AND SOCIAL ' WORK o ° t'.iAS5- Date TOTAL HOORL Y RATE 1YAGE5 GROSS AMOUNT CHECf DEDUGTJONS, CCNTRIBUTIONS AND PAYMENTS PAID NO SECURITY NUMBER o �'s IFICATION gl{14 8J05 I SIDE I 8ID7 I J3108 I ems 8110 HOURS OF PAY EARNED FOR3w OF EMPLOYEE r WEEK I Hours Worked Each Day } i THIS ALL Federai FICA R State SDI Vacation Heatth 8 Pension i S 0.00 8.00 0.00 0.00 8.00 O.DO 0.00 16OO S53 61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GABREE, PAUL PLUMBER r V!57.00 $202.06 S17970 S29.05 $0_00 $0-00 $0.00 611 Clenlanok Drive UNDERGROU 3 O 0.00 2.00 0.00 QA0 2.U0 O.aD D.00 4.00 570-87 Si,9"43 DID I NO UTILITY PIPEFITTER $1,141.24 $2,650.04 Training Adntin ! Fringes Travel 8 Sub Sub Savings 7v1a1 Other Total � I D 0.00 0.00 0.00 0.00 0.00 0.00 000 0.00 $0, 00 $8.00 50.00 $0.04 $0.00 50.00 $8.80 $686.81 Other Dedudbon Nales: Traininv Fee revere] ilia► a Slate SDI �Vacalior] FI&_ahh & pension S, OAO aA0 8.00 8.00 8.00 am am 40.DQ swim PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GARIBALDI. PLUMBER - 5563DO $230,87 $227.36 $3320 $OA0 $0.00 $0.00 ANTHONY P. O- Box 985 Sutter I UNJDERGROU 0 b 0-00 2.00 2J10 2.00 2.00 2.00 0.00 iD Da 37Q 87 63. 51,935 DID �85 ND UTILITY PIPEFITT ER r 52,853.10 $3.Q30.28 Training Adrnln 1 Fringes Dues Travel8 Sub Savirwjs Total Other Deduct- I$20.00 0 Q.90 U.00 0,00 0.00 0,00 0.00 0-00 0-DO $0-00 SO -Dv $0.00 50-00 50.00 $1,066.9 $12.50 3 Other Deduclion Notes: Training fee 1 THJS ALL Federal FICA & State SDI Vacation Heahh 8 Pension S 0,00 8.00 8.00 8,00 8.00 4.00 0.00 36.00 S53.81 PROJECT PROJECTS Tax Medicare Tax Holiday Weifare GIRARDIN. FLOYD I PLUMBER 1 $487.00 S219.32 32DB-88 $331.54 S0.00 $0-00 SD.00 P- O. Sex 102 River UNDERG RUU 1 O 0.00 2.00 2.00 2.0t] 2.00 Q-00 4.00 8.00 $70.87 S1,920.17 D!O Pin 75 ND UTILITY PIPEFITTER $2496.92 $2,888.71 Training Fr ges Dues T Sb& Sarongs Tolal Other OBduCL O 0.00 0.00, 0.00 0.00 0.00 0.00 0A0 000 $0.00 S17.60 $0.00 30-00 S0.00 S0.00 S191W $9fie.54 Other Deducbm Notes: Training fee THIS ALL Federal FICA & Stale SDI Vacation Health & Pemion S 0.00 8.00 8.00 8AU 8.00 8.00 0.00 40,00 S53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GRIEGO, DAVID PLUMBER) $521.00I $230.20 $226.49 $33.10 $0.00 so DO $0-00 1730 Rook Sp-ings Road Escond]do CA UNDERGROII 0 O U-00 2-00 2.00, 2.00 2.00 2.00 D.00 10,OQ $70.87 S7 998.49 DM ND UTILITY PFPEFITTER I $2,853-10 $3.030.28 Training Adng !es Fringes Dues Travel & Sub Savrrg6 Total °�'�' Detlud. 1 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 SOX S20.DO S0.00 $0.00 $0.00 $0.00 $21-DO $1.031.7 9 1 Other Deduction Notes: Train trig fee S - STRWHT TIME -DTHER -- Any olher deductions. caferbutiom ar4or paymeras whether or not nnuded or required by Prevailing wage dCGCm mOt Cm fnLMI be sepe ra" kW- CERTIFICATIDN tisuSr hr CdrOeted O = O1+ERTIME use e.tra streaks) rf naouscary. (See reverse s de) Form A-1-131 (Now 2-801 0 � DOUALETIME SDI -STATE DISABILITY INSURANCE Ca11fornia 2024 Herbert Walkup Pipeline Replacement I Herbert Walkup Pipeline Department of Indust►ialRelations. PUBLIC WORKS PAYROLL REPORTING FORM paw -3ofb (1) [2j I (3) 4; DAY ;51 'ti! 7; SIMITI,.VITIF15 NET NAME. ADDRESS AND SOCIAL � � WORK p�- I CLA55- Oafs TOTAL H01JRL v RATE GROSSAMOUNT DEDUCTIONS, WAGES CHECK CpNTRIBUTlflNS AND PAYMENTS PAID hO SECUR(1Y NUMBER IFICATla1! 8/04 18f05 1810E 187D7 18J0$ 18109 I $J70 HOURS OF PAY EARNED FOR OF EMPLOYEE NPEEK Hmws Worked Each Day THIS ALL Federal FICA 8 State SDI Vacatior Health & Pension S 0.00 0.00 8.00 8.00 8_00 8.00 0.00 32.00 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare LIMAS.ABRAHAM PLUM$ERJ =-DO $167.99 571.10 $24.15 $0.00 $0.00 50.D0 1535 Hussman Avenue Gardneruiile i UHIDERGROU 0 C 0.00 0.04 i.50 1.50 1.50 2,D0 0.00 6.50 570,87 $1 .852.77 2470 I UTILITY PIDITTE NFR $2.176,18 $2,211.61 Training Admin 1 Fringes dues Travel 8 Sub Savings Total Other TTotal 0 0,00 0.00 0.00 000 0.00 0.00 0.00 0.00 $0.00 SiS.40 S0,00 $0.00 50-00 $0.00 $15.60 $358.84 i -- - 01her Deducbon Notes: Tra'ninefee - F6tiflral FIUA& Stat9 SDI Vaca on Health 8 - Pens4w �- $ 0.00 8.00 8.00 8.00 EIVO 4.00 0.00 36.OD $0.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare MERCIER, BRANDDN r PLUMBERI S418.00 $20OA5 S183.65 $28.82 $0.00 $0.00 SO.00 400 Cragmont Court i UNDERGROU 1 O 0-00 2.00 2.00 2-00 2.00 0.80 0-00 8-00 570.67 -+-� $1,789.34 DID Cameron Park CA NO UTILITY ;2,496-92 $2,B38.(i6 Training Adg I Dues Trove! 8 Savings Total Other PIPI=FITTFU2 + Fringes Sub Deduct. i fJ 0.00 0.00 0.00 0.00 0.00 0-00 0.00 0.00 $0.00 317.60 $0.00 $0.00 SO-00 SA.00 $18.40 $849.32 Other Dedurllon Notes, Trainino Fee i THIS ALL Federal FICA & State 30l Vacation Health & Pension 5 0.00 8.00 B.00 8.00 8A0 8.00 0.00 40.00 S53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare FASTEN VELASQUEZ, PLUMBER t $283.DO $227.51 S213.75 $32-71 SO. DO $0.00 SO.00 ELISIO UNDERGROIJ 0 O O.OQ 2.00 2.0D 2 t]0 2.00 2.00 0.00 10.04 $70.f37 S2217-07 DM 742 Soum Dr 95776 i ND UTILITY PIPEFITTER D 0.00 0.60 Ono 0.00 0-00 0.00 0.00 0.00 SO.00 $2.853-10 $2,994.84 Train?ng 320.DC AdrnnJ Fringes SO -DO Oues $0-DO TravelSub b $0.00 Savings $0.00 OHTotal lar Oeducl, $20.80 $777.77 Dt#ier Deduction Notes: Tralnlna fee THIS ALL Federal FICA & Stale SDI Vacation Health & Pension S 0,00 8.00 BAD 8.00 8_00 8.00 0.00 40.00 580.00 PROJECT PROJECTS Tax Medicare Tax Holday Welfare PEREZ.SERGIO i PLUMBER $6W.00 $280.36 $290,51 $40.32 $0.00 $0.Do SO.00 149 Oak Ridge Drive i UNDERGROU O 0.00 2.00 2.00 2.00 2.00 2.00 O.DO 10.00 $E0.58 $2 355,61 D1D NO UTILITY � PtPEFITTER $3,205.80 $3,f,87.20 Training Adminf Fridges Travel& Sub Su6 Savings Total Other ❑etlucL 0 0-00 0.00 0,00 0.00 0.00 0.00 O.Do CDC $0.00 $20.00 SO.00 30.DO SO-00 $O.00 $22.40 51,331.5 i Other Deduction Notes: Trairmu fee 3 = STRAIGHT nME 'OTHER -Any Qlher deducWrG. C09*b000M antllar Parneets whether or not nd.ided or rcquir(4 by XvwTirV waW de1eeMVFWi0ns MU9 be seParataly WJ06 CERTFFIGTION MUST be ccmoleled 0 = OVERTIME Vse extra sheens) it rosary. ISec reverse sirs) Form A-t-131 (Now 2-0) p - 001 jM EnNF SDI - STATE DISABILITY INSURANCE California 2024 He iaert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline dcpanment of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page gaf6 (2} [31 4'r DAY (5) t6; f71 (8) } SIMIT�WITIFIS NET NAME. ADDRESS AND SOCIAL 9gi �0- I WORK Daly TOTAL }l6URL PRATE GROSS DE❑UCTIONS,CONTRigUTIONS AND PAYMENTS WAGES CHECK PAID SECii.lRITYNUMBER o�?LA'S z x u J I CAT N 8104 18/05 F $!0E I &D7 ! 858 1 aW I $110 F DUR5 OF PAY EARNED NO FOR OF EMPLOYEE WEEK Hours Worked Each Day _ _ I THIS ALL Federal FICA$ State SM Vacation Health& Penslon S 0.00 0.00 6,00 8,00 8.00 800 0.00 32.00 $53,61 PROJECT PROJECTS Tax Medicare Tax Holiday WeiFare REYWOSO,LUIS PLUMBER $368-00 $181.47 $161.32 $26.09 $0-OD $R,DC SO-00 SM Steelhead Avenue Kengs Beach NDERGR4U 0 O 0-OD O.M 2-00 2.00 2.0D 2.00 0.00 8.00 S70.8T 51.635-31 DID Total ' I ND UTILITY I PIPEFITTER __. $2,2$2.ag $2,388.79 -Training A ring 1 Fringes Dues Travel & Sub Savings Dtner Deduct � D 0.00 000 0.00 0,00 0,00 0.00 0,00 0.00' so-od $16,00 50.00 $0.00 $0.00 $0-00 $16.60 $753.48 r Other Deduction Notes' Training fee reoerat rtt�a a 518IB SDI Vacation Health & Pension S 0i0o &W 8.00 BM 8.00 8.00 O.DD 40.00 $5&61 PROJECT PROJECTS Tax Medotare Tax Hot day WeFFa e SABIA-MORGAN PLUMBER! $0.00 $232V $0,00 =-48 30-00 4000 $0DO 1413 Rancho Way South Lake Tahoe i UNDERGROU 0 0 D-00 2.00 2-00 2.00 2.00 2.00 0.00' 10.00 S70.87 - -- $2 778.11 D!D ND UTILITY � PIPEFCIi-ER $2.853-10 S3,0S5.77 Trsiring Ading f Fringes pugs 7raval8 Soh SSvings Ocher Tula! Deduct. I D 3.00 0-00 0.00 0-00 0.00 0.00 0.00 0-W $0- 00 520.[]0 $0.04 $0.00 $0-00 90.00 52120 5287.60 Olher Dedudion Notes. Tra in inu tee THIS ALL Federal FICA & Sh" SDI Vacation Health & Pads4n S 0-00 4.00 4-00 4.00 4,00 4-00 0,00 20-00 S94.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare TAYLOR- KRIS70AHER Opg{atin g S753.00� 336Y.02 5396.67 $a2.06 SO-00 $0.00 SO -DO 19730 Forest View Engineer 1 (Heavy& O 0.00 3-00 0.00 0.00 0.00 000 0.00 0.aa $125.2 1 $3,168.55 DID Circle Pioneer CA Highway work) f $1,892.80 54,772-70 i Training AQittin ! Dues Travel $ Sub Savings Dater Total I DOduct, Group 3 Area 7 ' FfxygeS D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $24.20 $000 $O.DO $0.00 SO-00 W.40 Si' 1 5 , Other Deduction: Notes: Tra i nin -- - THIS ALL Federal FICA & State SDI vaca4on Health u Pension S 0.00 4,00 4.00 400 4-00 4.00 0.00 20-00 $60.00 PROJECT PROJECTS Tax MadkMe Tax Holiday Welfare TAYLOR, KRISTOPHER PLUMBER 1 $753-00 $362.02 S39GA7 $62.06 $0.00 $0-DO S0.00 19730 Forest View UNOERGROU 1 O 0-00 2.00 2-00 2.00 2.00 2 DO 0.00 10.00 $80.58 $3.168.55 DID Circle Pioneer CA ND UTILITY PIPEFITTER $2.WS.W $4.772.70 Training Fri�s o T Sub& Savings Oedaucl- I ❑ 0.00 0.00 O-GO 0W 0-00 0.00 0,00 0.00 $0.00 $12-00 50-DO $q.0i4 50.00 SU,00 s40 40 51,6D4-1 5 f 011lar Deduction NoleS' ni S' STRAIGFIT TWE ti7HER - Any other deductions, conblibuWrrs arOOr payments whether or nor nduded OFMquMd by prevailing wage dcInUr lie[IN'S muse ne scparalely listed- CERTIFICATION iulM be �Ibmpleted FpRn A-1-1�1 {New 2��] ❑ = OVERTIME uW a tm VWX57 if rhoRser ey. (See mvcrw Side] D a 130013t.ET IME SDI = STATE 0I4SA81L1TY INSURANCE California 2024 Herbert Walkup Pipeline Rr3plaeernen[! Herbert'14alkup Pipeline Department of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM PageSofC {7} (2) dj DAY t7j [8] I9} sIMITIWITIFIS NET NAME. ADDRESS AND SOCIAL. if I aOc I WORK Date _ TOTAL HWRL yRATt GROSS AMOUNT DEDUCTIONS, CO NTRI BUTIONS AND PAYMENTS WAGES CHECK PAID � SECURITY NUMBER °=L I I CAT N BID4 I alas I aoG 18107 I am � 8m � alto t1OURs OF PAY EARNED FOR OF EMPLOYEE J I WEEK Hours Worked Each Day - - THIS ALL Federal FICA 9 State SDI Vacation Health 6 Pennon I S 0.00 6.00 8-00 8.00 8-00 8,00 000 40.00 599JA PROJECT PROJECTS Tax Medicare Tax Holiday Welfare AUSTVINCI GUEP.RA- I Operating $1,062.00 $457.11 $5",84 $65.73 SO.t101 $0.00 :0.00 Eodega Cocrt Et I Heav er Erg330 y & 2 {Heav ( D'I 0.00 2 [IO 2,00 2,00 2.M0 2.00 Q.QO 16 ,00 5132.7 1 $3.$76.77 t7ln Dorado Hills CA 1Hi way work 1 9 Y 7 _ j5,3i2.70 $6,042.61 Training Admin 1 Fr nges Dues Travel $ Sub Total Savings tYlher Deduct. Group 3 Area 1 lowI 1 D 0.00 0,00 ODD 0A6 100 0-00 0.00 0.00 1400 $ti0.50 50.00 50-00 50.00 S2,1G5.8 30.D0 567.i6 4 -- - Other Deduction Notes: TTr' ining fee reaerat H[ R a SC7[t3 theater HeaIHI Pension Holiday Wenare SDI S OA4 8.00 7A0 8A0 8.00 8.00 0.00I 39-DO S9.64 PROJECT PROJECTS Tax Medicare Tax VINCIGUERPLk CASEY I Oper2in9 S720-00 $364.08 5393.33 $52,35 S0.00 $0.00 $0.00 470 aroadmeadows I Engineer 4 (Heavy & ❑ O.DO 0-00 0,00 2-00 2.00 2.00 0.00 6-0p $132.7 1 53229.51 t71D Court Sutter Creek Highway ,yo* ! ) $4.982.22 $4.814,93 Training Admin ! Fringes Dues Travel & Seb Total Savngs Other deduct. won I Group 3 Area 1 1 I ❑ 0.00 0.00 O.OD 0-W 0.00 0.D0 OX 0.00 SO-00 55a.a5 sa as sa.00 Sa.oD $1,585.2 5a-Do Ess.ss 2 Other Dedua-0n motes- Training fee 1 THIS ALL Federal FICA Stale SDI Vacation Health & Pension S 0-00 8A0 0-00 8-00 8.00 8.00 0.00 32.00 S99.64 PROJECT PROJECTS Tax Medtcare Tax Holiday Welfare YOUNG. JIM 1 Operating $677•DO $331AS 5356.89 $47.67 $0-00 $0.00 S0.00 P.O. Sax I Engineer t (Heavy & ❑ 0.00 2.00 0-00 0.50 2-00 2.00 0.00 6.5a $132.7 -- $2.655.24 D1D F 95629 Highway 9 ay work] ! 1 $4.051-i0 ;4,3$2.87 Training Admit. J frirtgas Dues Travel 6 Sub Tdal Savings []that Deduct. C- oup 3 Area i 1 D 0.00 0.00 O.DO O00 0.00 0,00 0-00 0,00 3A.00 54fi-59 §04D' $0-00 $0.00 51.727.E SD,OO 531258 3 Other Deduction Notes: Trainitro fee. Cal Savers f THIS ALL Federal FICA & State SDI Vacation Health & Pensron S 0.00 5.0D 8,00 8,00 8.00 4.50 0.04 33.50 S53.61 PRC+JECT PROJECTS Tax Medicare Tax Holiday Welfare ZELLERS JEREMY I PLUMBER) S72$AO $160.63 $1Z735 $23.10 S0.00 $0.00 50.00 8194 MAIN ST MCKELUMNE HILL 1 UNDERGRDU 0 0.00 0.00 9.00 1.54 2-00 ODD D-O0 3.50 $70-87 51.419.55 DM CA 9524 1 ND UTILITY PIPEFITTET2 I $2,043.93 $2,11d-86 TrdinirxJ Acting ! Flinger Dugs Travel $ SuD Trxt I Savinngs ❑that Dedtx:t- 1 D 0.00 0.00 0-00 0.00 0.00 0,00 0.00 coo $0.00 514-gal $0.00 $0.00 SO.GD SO-00 5158.20 $69528 other L7eduction Notes: Trainina fee. Gan9shrnent S = STRAIGHT TIME -OTHER -wry other deductions- oontrfiuLom moor payrmne; whether or not nduded or requred by prcraiFrg wage determinarm ns must he separately listed. CERTIFK.ATION ITT be OWV40ad 0 = OVERTIME the extra shaosj if necessary. (See reverse alley Fpm A-1-131 (New Z-W) D = DOUBLET11AE 301 = STATE DISABILMY b4sURANCE California department of Industrial Rslattorrs STATE OF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOR r SLJ BGON TRACTOR Vinciguerra Constructlon, Inc. FIRST DAY AND DATE OF PAY PERIOD 81412024 do hereby certify under penalty of perjury: 2C24 Herbert Walkup pipeline Replacement Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM Page �2 of § CONTRACT NUMBER - Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD 811012024 (1) That I pay or supervise payment to employees of the aboya-referenced contractor on the above -referenced contract. At persons employed on said project fvr the above-rreferenced 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 an 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 ful[ wages earned by any person other than permissible deductions. (2) That this employer has complied with the tequirements 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: - - ---Ta-I Speafred 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 Re apprenticeship program registered with a State apprenticeship agency. (5) That fringes benefits as listed in the contract: (a) Have been or wil€ be paid to the approved plan(s), funds(s), or programs} for the benefit of fisted employee(s), except as noted below, (b) IJ Have been paid directly to the listed emp[oyee(s), except as noted below. (c) 0 See exceptions noted below. EXPLANATION EXCEPTION GRAFT I REMARKS: Except for Training funds for all crafts paid directly to CAC, NAME (PLEA E PRINT.) { TITLE r% W1. iA V t fkei+ V L� tY.3 ie �It SIGNATURE: DATE 91171M4 On federally -funded projects, permissible deductions are defined in title 29. Code of Federal Regulations, part 3, issued by the Secretary of Labor under the Copeland Act: (40 U. S. C. 276c). Also, the willful falsificelion of arty of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (See section 11DOi of title 18 and section 3729 of bile 31 of the United States Code). i CEM 25M ADA Notice For individuals with sensory disabilities, this document €s available in alternate formats. For information call (916) 6554-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1124 N Street, MS-89, Sacramento, CA 95814_ mom ornia 2024 Herbert Walkup Pipeline Replacement !Herbert Walkup Pipeline Departmegt of Department Wilmill IndustAalRelations PUBLIC WORKS PAYROLL REPORTING FORM Pageiof6 NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S LICENSE NO.: 3MB38 ADDRESS: P. 0. Box 157, Sutter Creek, CA, 95685 OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: (PAYROLL NO- FOR WEEK ENDING: SELF -INSURED CERT. PROJECT OR CONTRACT NO.: Herbert Walkup Pipeline I 19 8MM024 IWORKER5' COMP- IPROJECTAND LOCATION: 2024 Herbert Wakup Pipeline Replacement, ELD (1) (2) 1 (3) (4)DAY {5} (6) (7j 01 {9} I SIMITIWITIFISNET 1 NAME. ADDRESS AND SOCIAL �� WORK o��j CLASS- Dwe __ tctTc� HOURL Y � GROSS DEDUCTIONS. CONTRIBUTIONS WAGES AG CHECK AND PAYMENTS PAID NO SEgF x IFICATION $111 j $l12I8113 I8f14 I BI15 ISJi6I8117 "OURS OF PAY EARNED FQR EMPLOYEE i I WEEK Hours Worked Each Day { THIS ALL Federal FICA & State S01 Vacation Health & r Pension S 0.00 8.00 8.00 S_00 8.00 6_00 0.00 36-OD $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare CORREA, ERICK I PLUMBER! ^S201.()O $216-68 5,34.13 $31.16 SO.00 SO -GO $0.00 1535 Hussman Avenue Gardnervile I UNDERGR04i Cl C) 0.00 2.00 2.OD $.00 2.00 0,00 0.00 $.00 S70.87 $2.249.42 2412 I ND UTILITY I P1PEFITTE#2 $2,604.14 12,$52,19 TraiTrainingFringesFringesDues Admin ! Travel 8 Su4 Savings Other Total Deduct. O _V.00 _WW -0.150 0-M _ OAO D.00 0.06 $❑.au 518.40 $0-00 $0,00 Moo S0.00 $19.80 %02-77 Other Deduction Notes: Training fee ( THIS ALL Federal FICA & State S01 Vacation Health & Persian S 0,00 4.00 4-QO 4.00 4.00 4.00 0.00 20.0D S94.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN, THOMAS I Operating 5Tfl3.p0 $285.09 $2815-31 $40.99 SO.oa $0.00 $0.00 12650 C Shenandoah Road 95669 j Engineer ❑ (Heavy & 0 (Highway work ! 0.00 0.00 0.00 0-00 0.00 0.00 0.00 0.00 $125.2 1 Admin Dues Travel & S2,073.38 010 Total Savings MarGroupDeduct. } I Group $ Area 1 $1.892.80 $3,753.21 Tremrng Fringes Sob D I 1000,DD 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 S24.2C S>300 Woo SO-00 S0000 $364.4t $1,6T9.8 3 - - Other Deduction Notes: Training teec ar shrnent - THIS ALL Federal FICA & State SDI Vacation HeaM 8 Pension S 0.00 4.00 4.00 4.00 4.00 3.50 OAO 19.50 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN, THOMAS I PLUMBER 1 5703.00 $285.09 5286,31 $40.99 SO.00 $0 00 50.00 12650 C Shenandoah Road I UNDERGROU 0 0 0.00 2,00 2,00 2.00 2.00 0.00 0.00 8.00 S7❑_87 52-073.33 DID 95669 I ND UTILITY I PIPEFITTER $1.612.38 $3,753.21 Training Aingerl Fringes hues Travel& Sub Savings Other ToffiI L educL I D 0.00 0.00 0.00 0,00 0.00 0.00 BAD 0.00 Woo$i.fi79. $11.00 SO -DO i $D.00 5❑.O0 SO.00 $3Crt.44 3 3 I ` _ Other Deduction Notes' Trainino, fee. Garnish"" 5 - STRAM"T TIME ^OTHER - Any Omer aeGucsans. contntmtom andror paymnits whetr*r or not oduded or r%wred by prevw*V. vrege dcrermiratwu muss be sepsmb* Wed. CERTIF ICJ1710N MUST be compleind New 2�0 0 - OVE�ME use Ewa sheep) it r�xssary. ISee reverse side) Farm A-1-131 I ) 0 = DOUSLETDYtE SDI = STATE DISANLITY INSURANCE Calliforriis 2424 HGrl7ert 1JJalhup Pipeline Replacement (Herbert Walkup Pipeline Department of r"d"st,rlalRelation` PUBLIC WORKS PAYROLL REPORTING FORM Page 2ot$ (1) (2) I {3) � R4j DAY (S] isl i71 - - -- - -- - ($) -- - - - {s) - I SIMITIWITIFIS NAME. ADDRESS AND SOCIAL $a aO R 1 CLAS&- Date „� TOTAL lYRATEEURL GRCi55 Ah10tJNT DEDUCTIMaVS, CONTRIBUTIONS AND PAYMENTS WAGES PAID CHECK SECURITY NUMBER 93 IFICATION 8f11 18f12 18f13 I W14 I IV15 I &IS � V 7 HOU"' OF PAY EARNED FOR NO. OF EMPLOYEE I n WEEK I Hours Worked Each Day I THIS ALL Federal FICA 8 State Vacation Health & Sal Pension S O.OQ O.OD 0.00 8.00 8.00 0,00 0.00 16.00 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GABREE_PAUL I PLUMBER S277.0C $20820 S15425 $29.94 SO.tm $0.00 S0.00 611 G1enWvA Drive 1 UNUERGROU ❑ 3 0.4U 0.00 0.00 2.00 2.00 U.OD ODD d_410 i70.B7 $2022.27 i NO UTILITY PIPFFITTER Adrr►In! Travel 8 $1,141.24 12,730-46 Training Fringes Duee Sutr Savings i]ther Total Oedud. 0 0.00 0.00 O.DO 0,00 0.00 0.00 OX 0.00 $1100 $8.00 $0.00 $0.01) $0.1X $0.00 $8.80 $70B.19 OtherOedudion Notes:Irainina reaeral rYl:►ta state - SDi Vacation Health & PertSim j S 0.00 SAD 8.00 8.00 t3.Q0 8A0 0.00 40.00 S53.B1 PROJECT PROJECTS Tax Medrear@ Tsrr Holiday Weitare GARI I PLUMBER I - 30.00 $235-59 $0.00 $33.97 $0.00 $0.00 sow QNYI P. O. Box 985 Sutter UNDERGROiJ 0 O 0-W 2.00 2.OQ 2.00 2.00 0.00 0.D0 1i.00 570-87 - S2,8T0.29 DID �5 RI UTILITY I PIPEFITTER 52.713.38 $3.101.15 Training Adrsdn1 Fringes Dues Travel& Sub SavirV Tots) Other Deduct, t D 0.00 0-9D 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $19.20 $0-QO $0-00 S0.00 SO.00 $21AG $29D.36 - O her Deducllon Nolen: Training fee THIS ALL FederaF FICA 6 State SDI Vacation Health & Pension - S 0.00 8.00 8.00 8.00 S.M 8.00 O-W 40.00 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiviay Welfare GIRARDIN.FLOYQ f PLUMBER 5599.D0 SMA9 $256.66 $3715 $0.00 30-00 SO.00 P. 0. Box 102 River I LINDERGROU 1 O Q.00 2-DD 2.04 2.D0 2.00 D.5D 0.0G $.50 570.87 $2 275.4fi D!D Pin 5 j ND UTILITY PIPEFITTER $2,746.80 $3,454.58 Training Admin f Fringes Dues Travel &Total Sub Savir:gs Other Deduct. 0 0.00 0.00 0.00 0.00 0.00 GAO 0.00 0.00 $0.00 $19.40 50.00 7(I.DO 50.00 SD.OD $1.179.1 523.20 0 I ` Other Deduction Notes: Trainina THIS AL' Federal FICA 8 Stalg SUI Vacation HBafth $ Pension S 0.00 S.DO 0.00 0.00 8.00 S.50 0.00 22.50 $53.61 FROJECT PROJECTS Tax Medicare Tan Holiday Welfare GRIEGO. DAVID + PLUMBER I $4.33.D0 $20TM $188.89 $29.90 $0.00 $0.00 $0 00 1730 Rock Springs Road Escondido CA UNDERGROII 0 0 0.00 2.00 0.00 0.00 2.00 0.00 OAO 4.00 $70.a7 51.$58.33 D(l) ND UTILITY PtPEFITTER � $1,489.71 $2,737.26 Training Frnin 1 Fringes hues Sub Travel & SaYeigs Other Total Deduct, 0 0.00 0-00 0.00 0.00 0.00 0A0 0.00 0.00 $0.00 sTfl-so $0.00 $0.00 sD.00 sG.oa $19-M $878.93 Other Deduction Nolen; Tratnino fee g = STRAIGHT 71ME 'DTHEtt -Wry o7wr deduCWa. []onErihlltiorrs ar'& r Paymor4s whether orrrpl Muded or reored by prw@iMg wage iwom nations arrest [re aeparalay listed CERTIF"TidN l 1, T be compkdod a _ OVERIIME Use exva sh"KS) 0 rrepessary. (See reverse side) Fo A-1-131 (New2-W) p. DOUBLETIME S[H = STATE DISABILITY INSURANCE is J0.1 DePart Department of 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page I of (1) (2) 1 (3) (4) DAY (7. i$) {9] I SIMITIWITIFCS NAME,ADDRESScztp AND SOCIAL WORK Data HOURL NET SETY R rL CLASS- zF 1F(CAT€ON 81i1 r8112 18113 1 8114 1 WIS f TOTAL HONKS Y RATE GROSS AMOUNT NFp WAGES CHECK DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID OF ECURMPLOYEE v i 8116 18117 OF PAY OR Hours Worked Each Day WEEK S 000 8.00 8.00 6.00 B-00 6-50 ODD 3850 $53,61 THIS ALL Federal PROJECT PROJECTS Tax FICA 8 Medicare State Tax SDI Vacation Holiday Health & Welfare Peron LIMAS. A13RAHIAM15M PLUMBER! iAven Hussman Avenue Gardnery Ne I UJNDERGROU 0 4 S217.00 $218.72 $13o.68 $31.45 $0.00 40.00 $0.06 I ND UTILITY t1.00 2,p0 2.00 1,0q 2.00 D.OQ O.00 7A0 STATT $2,261.15 2413 I PIPEFITTER 52,560.06 $2.379.00 Training Adnges Dues Travel Savings Other Suh& De-Ifdlt, D 0.00 0.00 0.00 0.00 0-00 0.00 O.GO 0.00 $0.00 � I I $18.20 $0.00 $0.00 $0.00 SO.DO $Z0:00 I $617.85 tither DeducSon Naves: Training' S 0-00 8.00 8.00 8.00 8.00 5.00 O.00 3TDO $53,61 r„o -4. rauerat PROJECT PROJECTS Tax rK A 5 Medicare JTate Tax SDI Vacation Heahh & P2nsUn hAERCIER, I Holiday WO -we DN PLUMBER 1 �`� 5431.00 400 Craragrnnnt Court UNDERGR011 $210.57 5189.25 $3028 SO.00 $0.00 $0.00 Car Cameeron Park CA t I ND UTILITY O OLD 1.00 2.00, 2.00 2.00 O.W D.W TOO S70-87 57.891.48 DID P[PEFITTER � $2.d79-6fi i2,771.78 Training Admin 1 Dues Travel & Savings Total Other Frin[je5 sub Deduct. � D 0-00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 I $17.60 $0.00 $0-00 $0.00 SO -DO $19.20 $880.30 Other Deduction Notes. TTmining lea I S 0.00 B AO 800 8.00 800 3.50 0.00 35.60 53 $.61 THIS ALL Federal PROJECT PROJECTS Tax FICA & Medicare State Tax SDI Vacation Health & Pension PASTEN ' Holiday Welfare UEZ PLUMBERl � 5213.00 ELISIO EL00 UNDERGROU RGR 0 $20s.20 $181-36 $30.08 S0.00 $0.00 SG.00 742 Bourn Or NO UTILITY O 0-00 2.00 2.00 2DO 2.00 0.00 000 8.00 $70.87 W 9577ti PIPEFITTER $2,470.12 $2,753.90 Training Dues Travell& Savings 32,100-96 DAD Other oral Fins ub ucL D O.DD O.Op 0,04 0,00 0.00 0.00 0.00 0.00 $0.00 S17.40 $0.00 $0.00 5000 SO OD $19.00 $652.64 (A her Deduction Noses: Training fee S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 $60-00 THIS ALL Federal PROJECT PROJECTS Tax FICA & Med.care State Tax SDI Vacation Health & Pension I Holiday Welfare PLUMBER/ 149 Oa Ridge D 149 Oak Ridge iarive UNDERGROU S672.00 $272,10 S279.47 $39.12 $0-00 $0.00 50.00 1 � N❑ UTILITY O 0.00 Z OO 2.00 2-00 2.DO 0 00 0.00 8.00 SODAS p€PEFITTER $3.043.60 $3,578,70 Training Admin I Dues Travel a Saviovs 52,294.21 DAD Other Total � Fdi19S19-20 Sub Deduel- D 0.00 0.00 0.00 0.00 i I 0.00 D.00 0.00 0.00 $0.00 $3-00 SO.DO $0.00 I $0.00 51,duct- $21.80 B Other VWWion Notes: Tra€nino Foe S = STKA)T�M T1 ME ETHER - Any other tledxEianS. ccrw nut ons aM or paymrrys wrrHher a rql OVERFKbAkd or M!Qwred by s krg wage determiner ons mSW uSI be parat* G 6ted. CERTIFICATIDN MST be oompldod lam A-1^131 ('yk- 2-H0) O = D = OOUBLETSl MEprxl DOUse extra sh"ga) it neowaary. (See reverse sides Ot3LET S01= STATE DISABLITy INSURANCE California Department of 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page A of F 11} {2} 1 (3) (4)DAY i'5 ;6) f7 I81 -I S I m I T I W I T I F I S lgl NAME, ADDRESS AND SOCIAL z z I �o WORK I DaOe HOURL NET SECURITY a GLASS- zF I IFICATION 8f11 I W12 18J13 18114 I W15 TOTAL GRS GROSS AMOUNT EARNED WAGES DEDUCTIONS, GONTRIBiJTIONS AND PAYMENTS PAID C ECk OF EMPLNOYEE� I efts 18117 OF PAY FOR NO. I Hours Worked Each Day WEEK I S 0.00 8.00 8.00 8.00 8.00 8,00 0.00 40A0 $53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA& Medicare State Tax SDI Vacation Holiday Health & Welfare Pension SABIA, MORGAN I PLUfNBf=f21 1413 Rancho Way South Lake Tahoe I UNOERGROt:I 0 5492.t?0 $22751 $214-32 $32.72 $0.a0 S0.00 54.Oo I NO UTILITY 4 0,00 2.00 2,00 2-DO 2.00 0.00 0.00 8-90 $70_8T 52,i107.49 DD PIPEFITTER $2,711.36 $ZM.&4 Trainin g Acing 1 Dues Travel & Sav" Other Total Fnnges Sub Deduct. D ODO 0.00 O-DO 0.00 0.00 0.00 0,00 I7.D0 $0.00 i I I S1920 SOOD SO,00 SO-00 $0.00 $20.80 $957,35 Other Deduclim Notes: Tta_uring fee - - - - - - -- III S -- ORO 0,00 8.00 5.00 4.00 0.00 0.00 20-DO $94.64 irntJ ---I, � rea97ai PROJECT PROJECTS Tax Yl[;A Ce Medicare Sia[C Tax Sol Vaea�ia-n Holiday !l�W& - --- - - - -' Welfare Pesi non TAYLOft. i(FtI5TCPHF_R I opersnng �� iiraeer 19720 Forest View En g S125 2 $505.00 $386.50 $418.88 555.57 SO-M 30.00 S0.00 Circle Pioneer CA 1 [Heavy & 0 a.00 0-00 2,00 2-00 O.OD 0.00 0.00 4.00 I $3 386.37 DID 956 Highway work)1 I Group 3 Area 1 $2,393_&1 S5,096.36 Training Admin f Dues Travel & Savings Total Other Fringes Sub Deoud. I 0 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.G0 50.00 529.04 50.00 30.00 SO-00 SO-00 57,70s-9 $44.04 9 Other DeductiX Notes. Trainino I S 0,00 SAD Q_0D 0.00 4.00 8.00 0,00 20.00 $60.00 THIS ALL Federal PROJECT PROJECTS Tax FICA& Medicare stale Tax Sol Vacation Holiday Health& Welfare Pension TAYLOR, I K 730-Fo rest 79730 Forest View PLUMBER 1 I UHDERG{dOiJ S805.D0 $386.50 S418.88 S55.57 `$0.00 $0.00 $0.00 Circle Pioneer CA 1 NO UTILITY fl 0.00 2.00 0.00 0,00 2.00 1.00 0.00 5.0D $80.45 $3 38&37 D70 95fit3B I PiPEFITTER $1.602.25 $5.096.36 Training AdrNn1 Fri+iges Does Travel$ Other Total Sub DeducL I a a.00 DOD - 0,00 0.00 0.00 o,00 a-aa - 0.00 $a.00 S10.00 50.00 W-00 $0,00 $0.00 s 9 $44-04 1.7a9 s Other Deduelion Notes IrAi9i { S 0.00 S.Oo 5.50 8-00 8.00 8.00 0.00 37.50 $95.64 THIS ALL Federal PROJECT PROJECTS Taut FICA & Medicare State Tax SDI Vacation Health & pension Holiday Welfare USTIVINCIUERRA, A30 I OPeraUng Bod 3od ega Court El I Engineer $132.7 S947.DO $442.04 $478,12' $63.56 Sa.00 $0.00 S0.00 Dorado Hills GA 2 (Heavy & IHighway O 0.4D 2.00 0,00 2.00 2.00 0.00 0.00 8.00 1 13 84-6,48 UID work) 1 Group 3 Area 1 $4,532.76 S5,843.54 Training Adrrin 7 D," Travel 8avings S Cther Total Fri»ges Sub Oedud. lamI ❑ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.04 $52.64 SO-00 Illmo0 SO.00 SO.00 S65.34 $1,997.6 6 Other deduction Nores' TTr irlrng fee S STRAIGHT TIME -OTHER -Any other dcdvctons. � arw*or payments whether or not nduded or recturm by prevaifvi9 wage dekxminations ft st be separately listed. • vo CERTIFICATION NMbe comaietpd Fam A-1-131 (New s-0) use extra shaclRsj r ncCCSSary. ❑ = oouss_En ME (sce rcvcrge side) SDI . STATE DtSABILrrY INSl1RANCE 4dM�Caifemia 2024 Herbert Walkup Pipeline Replacement ! Herbert Walkup Pipeline Department of IndusWalReladons PUBLIC WORKS PAYROLL REPORTING FORM Page 5of6 (1) (2) 1 (3) (4)DAY i5l 6; 7:: ($) (9) I S I M( T I IN I T I F I S NET HAM I-. ADDRESS I WAGES AND SOCIAL i5° c WORD Dale TvrA> hOUHt GR4SSAMaUNT CHECK v RATE DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID SECURITY NUMBER z % I CLASS-- $lii 18172 18193 18174 I SJ15 18176I 8177 R5 OF PAY EARNED FOR Nb OF EMPLOYEE, � WEEK Noes Worked Each Day THIS ALL Federal FICAA State Vacation Health $ Pension S 0.00 ax Q,00 e.00 8.00 0.00 0.00 2d-00 $99.64 PROJECT PROJECTS Tax Medreare Tax SDIHoOday Welfare V INCIGUERRA, ) Operating - - 5403.00 $284 25 5248.26 $37.99 $0.00 $O.Oo 1�f100 CASEY � Engineer 470 Bmadmeadom 4 (Heavy & 0 0.00 0.50 0.00 ❑ 50 2.00 0.00 0.00 3.00 $132.7 $2,50D.8(I DID Court Sutler Creek IH Highway wort[ ! 1 Adman 1 Travel & Total r9 Y } $2,MA9 $3,486.97 Training Dues Savings Other Group 3 Area 1 Fringes Sub ❑educt I ❑ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0-00 $32.67 SOAO $0.00 SO.00 30.00 $32 67 $986.17 Other Deduction Notes, Training fee Cal Saves - - --- -7:iw - -.acc reuerat ri-A& atate- Vacation Health S OA4 0A0 0.00 8.00 8.00 7.00 0.00 23.0 i58.61 PROJECT PROJECTS Tax Ailed care Tax SUI Holiday Welfare Pension WIi1SC7N, SLOAN PLUMBER 1 5282.00 $162 04 $121.$9 W3.30 S0.00 $0.06 $0.00 3020 Newton Road. UNDERGROU Sp, 1 Placerville CA 5 ( ND UTILITY 0 0.00 0.tH1 0.00 7.50 2.00 0.00 0-()0 3.50 S7087 Total $1 413.60 0!❑ PiPEFITTER $1.451-08 $2,129-01 Training Fringes sues T SubSavings Other Deduct D 0-00 0.00 0.00 0.00 0.00 0-00 fl.00 0.00 $0.00 S10.60 $0.00 $O.tX} 50.00 50.00 S126.18 $715.41 Other Deduction Notes: Training fee, Garnishment 1 THIS ALL Federal FICA& State Vacation Health S 0.00 8Ao 8-00 RAO B-00 8.00 0-00 40,00 SW" PROJECT PROJECTS Tax Medicare Tax SDI Vacation Welfare P�4r YOUNG. it I Operating � Engineer 5891.1}0 $41$.89 5449.99 Y59.9•f $0.OQ $0.00 $0.00 P. b. Box 58 1 (Heavy & 0 0.00 2A0 2.00 2.00 2.00 0.00 0.00 8.00 $132,7 $3,314.46 ❑IO S$62g IHighwaywork)r f $5,047.2$ $5.511.77 Training Adminl i]ves Travel& Savings Other Total I Gry p 3 Area 1 Fringes Sub l3aduct. D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $2,197. $58.08 50,00 $0.00 50.00 30-00 5379.49 1 1 Other Deduction Notes Training fee. Cal Savers - _ THIS ALL Federal FICA 8 State Vacation Health & S 0_0D 8.50 8.00 8.00 8.00 7.00 0.00 37.50 W.61 PROJECT PROJECTS Tax Medicare Taut SDI Holiday Welfare Pension ZELLERS,JEREMY PLUMBER MI_00 $175.90 '$142.52 $25.44 $D.DD $0.00 SO.00 8194 MAIN ST I LINDERGROU MOKELUIMNE HILL 0 I Q 0.00 0.00 0.50 1.50 2.00 Q.QO 4.00 4.00 570.87 $1'.rG5-fi4 DID NfJUTfLfTY Adman! Travel Tp1af I PIPEFITTER - $2.293-86 $2.329,30 Training Fringes Dues Sub Savings other Deduct I D 0.00 0.00 0.00 0.00 0.00 0-00 0.00 0.00 $0.00 I 546.60 $0.00 $O.DO 50A0 SO,OD g15780 $763.68 Other Deduction Notes_ Trainino fee. Garnishment S = MRAIGKT TIME 'OTHER-Aay oiler daductlons, canrktADM arrdror payments whetimr or not i`duoed ar rmuroo by prevajYng wage de a mw"ians mL= be separaieh kw& CERTIFICATfOM lM he completed O = OVERTWE U7 a extra sWks) if nemssary. (See never5e side) Form A-1-131 (Now 2-ee) D = ❑OUTA ETIME SM = STATE DISABILITY INSURANCE C a Department of Industrial Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE ICONTRACTOR1 SUBCONTRACTOR Vinciguerra Construction, Inc. JFiRST DAY AND DATE OF PAY PERIOD 1 811112024 1 do hereby certify under penalty of perjury: 2024 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 W1712024 (1) That I pay or supervise payment to ernptayeas of the above -referenced contractor on the above -referenced contract. Ali 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 indire(My to or on behalf of said contractor from the full weekly wag as 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 payrolfs otherwise under this control required to be submitted for the above period are corrod and complete; that the wage rates for laborers or mechanics contained therein are not less that the applicable wages rates: (a} F—Tp*0 l�J;rrdFtfaq,PuCao1ewage aetetrntnatron rncorparated into the contract; - - (b) Q Determi ned by the Director of Industrial Relations for the county or oounUes in which the work is performed: that the classification set forth therein for each laborer or machanic conform with the worts the 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) F1 Have been or will be paid to the approved plan(s), funds(s), or program fs) for the benefit of listed emplayee(s)- except as noted below. (b} Q Have been paid directly to the listed employee(s), except as noted below. (c) See exceptions noted below. EXCEPTION GtiAFT REMARKS, Except for Training funds for all crafts paid directly to CAC, EXPLANATION - - NAME (PLEASE PRINT.) �ry TITLE %`t V3 Tj rl Lf t 4o7-,,,— P i' if i SIGNAT7JRE: DATE 91712024 On federally -funded projects, permissible deductions are defined in title 29, Code of Federal Regulations. part 3, issued by the Secretary of Labor under the Cope fand Act, (40 U. S. C. 276c). Also, the willful faisfflcatfon of any of the above statements may subject the contractor or subcontractor to civif or criminal prosecution (See section 1001 of title 18 and section 3729 of title 31 of the United States Code). ADA Notice For inc!Nidtralswith sensory disabilities, this document is available in alternate formats. For information call (916) fi54--6410 or TDD (916) 654-3880 or write Records and Forms cEM 2501 Management, 1120 IN Street, MS-89, Sacramento, CA 95814.