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Certified Payroll Records 20 thru 24_RedactedCallparttnenfamia JON Aet of 2024 Herbert Walkup Pipeline Replacement J Herbert Walkup Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page I of 5 I NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR`S LICENSE NO.: 358838 ADDRESS P, 0. Box 157, Sutter Creek, CA, 95885 JOR SUBCONTRACTOR- SPECIALTY LICENSE NO.: PAYROLL NO- I FOR WEEK ENDING. ORCONTRACT NO. Herbert WalkupPipeline J 20 Ij $12Af'2024 ISELFaNSUMDCERT: WORKERS' COMP- �PROJECT PROJECT AND LOCATION: 2024 Herbert Wa Ikup Pipeline Replacement, ELD (1) (2) 1 (3) (4) DAY (9) Tw 7� l= I I � S NAME, ADDRESS ?° J 1 NET AND SOCIAL o_ WORK v�0.� CIAO Date TOTAL HOURL YRATE GROSS AMOUNT i]i=DUCTIO�lS, CONTRIBUTIONS AND PAYMENTS WAGES CHECK PAID SECURITY NUM'•BER a y 1FfCATr[7N' 8l18 8y19 18120 181Fi 8122 8f23 18R4 Ht7uR5 L7F PAY EARNED EMPLOYEE 1 WEEK Hours Worked Each Day I THIS ALL Federal FICA & State SDI Vacatm H�lealth $ Pension J S 0.00 8,00 0.00 0.00 0.00 D.00 O.DD 800 S53.61 PROJECT PROJECTS Tax Medicare Tax Holi(laay Welfare CORRE A, ERICK 1535 Hussman I PLUME9ER ! $0-00 $108.42 $12,76 $15.59 $0.00 $0.00 5D_9D Avenue Gardnervile UNDERGROU 0 J NO UTILITY O 0.9D 1.00 0.00 0.D0 O.OD 0.00 D.00 7.00 $70.87 $ 1.280.50 2417 f IPEFITTER J $49935 $1,427,47 Training Admn f Fringes Fringes Dues Tr$Ub & avet Sub Savings O Total Deduct I V.w M VA u.UU U.uL( 0.uo #0,00 53.60 $4.00 $0.00 50.00 SO.f]0 $10.201 I $146.97 Other Deduction Notes:'Training fee 1 THIS ALL Federal FICA & State SDI Vamdon Health & Pension I 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 COWAN, THOMAS I Opera&V 12650 C I Engulesr $659.00 $261.38 S268.18 S37.59 $0.00 $0-00 $0.00 Shenandoah Road 56E9 0 I (Heavy & O Highwayf 0.00 0.00 0,00 0.00 0.00 0.00 0-DO 0.00 $125.2 1 ! Trsvel8 Total $1 852-76 Oft? Area {xgup 3 Area 1 $1.892-80 $3-451.55 Training Fringes Fringes Duas Sub Savlrgs Olher Deduct. ❑ 0.00 0-00 0,00 0-00 0.0D 0.00 0,00 0.00 $0.00 $24.20� $0,00 Saw So.ro W,00 $372Z4 $1'59B7 Other Deduction Nolen: Trainimg fee. Gnrruahm _rit THIS All Federal FICA& State SDI Vacation Health & Pension S 000 4.00 4.DO 3.50 4.00 3.00 0.00 18.50 $53,61 PROJECT PROJECTS Tax Medicare Tax Holitlay WeHare COWAN•THOWS 12650 G J PLUMBER! 1 $859.00 $261.38 5268.18 j37.59 S[1.90 30.00 S0.00 Shenandoah Road UNDERGROU ND UTILITY O D J 0.00 2.txi 2.00 0.00 2.00 0.00 0.00 fi.00 &70.87 51:852.76 DID 95669 PEPEFITTITTEit #1,417.01 #3.451.55 Training Admin y Dues Travel8 Tot al 'avw°g' Other J Fringes Sub Deduo ct J O D.DO 0.00 0,00 0-00 0.00 0.00 0.00 0,00 $0. 00 #9.80 50,00 $0.00 $0.00 7598. $0.00 $372_64 51.9 J Other Deduction Notes: Training fee. Garnishrnenl s = STIiAr-4iT TIME 'OTHER -Any 6ttrer tletluCtiorls, cminbub s aridlor Payments whe6w or nod gKkXW or regrarad by prev"M wage dslermnalrm must hC separat* kshed. CER7IFICATI(N M11ST be eompiete6 0 = OVERTIME use extra ov"Ks} if necessary- (See reverse side) Form A-1-131 tNew 2-aD1 D = DOUBLtMME 8i71=STATE OISABILITYINSUAAHCE California CHOI Deparlmentof Industrial 2024 Herbert Walkup Pipeline Replacement) Herbert Walkup Pipeline Relations PUBLIC WORKS PAYROLL REPORTING FORM {1] I - i) (3) - Page 2 of (4)DAY {S) (6) t7) (e) - s I I NAME, A©DRESS is AND SOCIAL SECURITY NUMBER OF EMPLOYEE o��j WORK CLASS—TOTAL z fHOURS w' IFICATIDN IYi8 I NIS 8l20 Dale 18l21 ] 8f22 8123 8124 FIRATE Y RAC OF PAY GROSSAMOUNT EARNED NET WAGE $ f}FDUCTIONS, CONTRIBUTIONS AND PAYlu1ENTS PAID CRE4;K FOR ND. I Hours Worked Each Day WEEK S 0-00 B-00 8.00 6.00 8-00 7.00 0.00 39.00 $53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA 8 state Sol Vacation Health $ piton DI,I Medicare Tax Hdiday Welfare B x PLUh!eER F � P, 0. P, O. Box 985 Sutter 9 UNDERGROiJ 0 l7 O.GQ 2.00 2.00 O.iiO 2.pp 0,00 0-Q0 S463.00 $199.19 S185.00 $28.64 $0.00 $0.00 50.00 85 NO U71LITY fi3OC s70.87 PIPEFITTER $2,516.01 $2-622.32 Training Adman I Dues Travel & $1.727.89 DID Sayir, s flitter Total g Fringes Sub oeduct D 0.00 0.00 0.00 0.00 0,00 0.00 O. Do 0-00 50.00 S18.00 $0-00 S0-00 so -cc S0.00 S1a.60 $694A3 I Other Deduction Noleg: mmdag - - I 5 0.00 8-00 ON 8.00 8.00 7.00 0,04 39.00 553-tit , PROJECT PROJECTS reveral Tax Medicare Tax SDl U Cam --two H®aalt A - Pension GIRARD F{nm I PLUMBER/ HcQay Welfare fl. Box 102 River , UNDERGROU $46E.00 $212,67 S194.98 $30_57 $0-00 So.00 S0.00 �P. 75 � ND UTILITY O 0.00 P.00 2.00 0.00 2.00 0-00 0.00 8.00 $70-87 PIPEFITTER _ $2.516.01 52,799 49 Tra.ning A rNes Dues Travel a 51.870.67 Wp Total Savings oiler 1 �9 Sub Deduct, D 0.00 Ia.OD {).Do 0.0p 0.00 a.oG 0.00 Q.oc �O.oQ S18-00 $0.00 $0.D0 S0-00 $0.00 $19.60 S928.82 Other Dedudion Notes: M S. 0.00 8.00 8.00 0,W 0.00 0.00 0-00 16.00 $53.61 THIS ALL Federal PROJECT PROJECTS Tax FIGA & Medicare State Tax Sal Vacation Health $ �. Pension ,RIEGO, DAVID Ho! )day Welfare 1730 Rock Springs PLUMBER! I Road Escondido CA 0 UNDERGROU I NO UTILITY O 0,00 2.00 2.00 0.00 0.00 0.00 0.00 4.Q0 $70.87 S48#.04 E217.33 5209.28 E31 25 3Q.QD $O.QO $O-00 9P026 - I PIPEFiTTER - $1.14124 S2,860.82 Training AdminI Dues Travel8 Savings Other Total $1902.16 Olf] I Frirlpe5 Sub Deduct D 0.DO 0.00 0,00 0.00 0.00 ❑.00 0.00 0.00 L0.00 1 $8.00 S0-00 $0.00 50.00 $0.00 y19.80 59M 56 Other Deducldon Notes: jMIniny tee I 5 + 0-00 8.001 0.00 0.00 0.00 0.00 0.00 8.00 $53.61 THIS ALL Federal FICAS PROJECT PROJECTS Tax Medicare Stale Health ,& Pension Tax SDI I HoWan Hd Welfare 1535Hus$rian 1535 Gardn PLUMBERI 1 ie AvenueGardnervrlla 0 O 0.00 1,00 000 0.00 o-00 0.00 0.00 $0.00 $108A2 $6.67 $15,59 $0.Gr0 $0.00 SO-00 NO I NIP UTILITY PIPEFITTER 1,00 $7087 Admin 1 Travel $1,885.59 2E18 1 $499.75 =1,427.47 Tr8krlrlg Dues & Savings Other Total 1 Fringes SUO Deduct D 0.fl0 0.00 0.00 0.00 0.00 0-DO 0.00 000 4000 I 33M S0.00 j0,p0 som $0.00 $10.20 $140.88 OthefOWLMronNotes: Lea iniAfte 5 = STRAIGHT TIME O = OVERTIME 'OTHER -Any oUxir deductions oorltributiwis andror peorer� whetter or not kdudcd or u mn �4 pr6"afinp rrdg[r dWerm rtalims must bs Form �1-13 t (Nw. 2�p) D = DMBLE1iME Lho extra sheet(sj rf heceasary, sepam ley isled. CERTIFICATION NLM ee eomplEtcd SDf =STATE DISABILITY INSURANCE (See reverse soe) California Department of 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3of6 41f (2j 1 (3) (4)DAY (5) :es 7 (8) (9) ! S I M I 7 f W I T, F i S NET NAME,ADDRES$ AND SOCIAL ps i WORK ASS Data TOTAL IRATE GROS5AMOtiN7 WAGESCHECK SECURTY NUM8ER d CLASS iKK1R5 Y EARNED DEi3t1GTICINS, CONTRIBUTIONS AND PAYMENTS PAID NO. OF EMPLOYEE _ x IFICATION 8I78 I S119 18120] 8r21 8122 18123 8124 or PAY FOR u + WEEK Hours Worked Eaa Day I THIS ALL Federal FICA & Stale SEII Vacation Heah#r & Pension $ 0.00 6.00 8-00 8.00 8.00 6-DO O.DO 40.00 S63-61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare MERCIER, BRANOON PLUMBER! $0_M 523021 $0.00 $33.10 $0.00 $0-00 S0.00 400 Gragmont Courl 1 UNDERGROU 0 0-00 1.30 2.00 2.00 2.D0 2.00 0.00 9.50 S70.87 $2 745.97 DM Cameron Park CA ND UTILITY Adn1in I Travel & Total PIPEFITTER $2.917.67 53,030.28 Training Fringes Dues Sub Savings Other Deduct ❑ 0.00 0.00 0.00 0.00 0.00 0-DO 0.00 0.00 $0.00 S19.80 $O.DO $OZO SO.00 SC-00 521,00 $284-31 a Other aeduetian Notes' Training fee l , iI� ni rooerai I,IUA & State Vacation Vacation Health & Pension j S 0.00 6-50 8.00 D.DO 0.00 0.00 0-00 14-50 S53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare PASTEN VELASQUEZ. PLUMBER 5153.00 $182-25 S153.21 $26.21 Saw $0.00 50.00 ELISIO UNDERGROU 742 Bourn Or NO UTILITY Admin 1 Travel & Total 0 O D-00 D.00 2.00 0-00 0.00 D.DO 0.00 2-00 570.8T S1,867.58 DID ] Woodland CA 45776 PIPEFiTTER $919,09 $2,399-25 Training Fringes Dues Sub Savings Other DeduuL - ! 00 0 0.00 0.00 D-00 0.00 0.00 0.00 0.00 0.00 $C- { $5.60 50A0 $0.07 54.00 50.00 $17.00 $531.87 Other Deduction Nales Training foe THIS ALL Federal FICA & State Vacation Health 8 S 0-00 8.00 8,00 8.00 8.00 SjW 040 40.00 S60.00 PROJECT ' PROJECTS Tax Medcare Tax $DI Holiday welfare Pension PEREZ, SERGIO I PLUMBER 1 5554.D0 $237.49 $233.18 $34.15 SO -DO $0.00 SO-00 149 Oak Ridge Drive I UNDERGROU ❑ 0.00 2.00 2,00 0.50 2,00 0.00 am 6.50 S80.45 S2.035.63 DID ND UTILITY Adrnin ! Travel & Total PIPEFITTER $2,922.93 $3.124.05 Training Fringes Dues Sub Savings Other Deduct. D OA0'i 0.00 Ono 0_n0 0.00 0.00 0.0e 0.00 $0.00 $16-60 $0.00 $0,00 $0,00 $0-00 $19-60 $1,a88 c Oher Deduction Nolm. Training fee THIS ALL Federal PICA & State SDI Vacation Health & Pension S 0.00 $.OD 0.00 0,00 ODD 0.00 0,00 8.00 S53-61 PROJECT PROJECTS Tax Medicare- Tax Holiday Welfare SABIA, MORGAH I PLUMBER/ $254.D0 $142.87 5109.69 VO-64 $0.00 $014 $0.00 1413 Rancho Way UNDERGROU South Lake Tahoe 0 ND UTILITY D 0.00 2.00 0.00 0.00 0.01) 0.00 0.00 2.D0 STO-87 $1.340.44 D1D CA 961 PIPEFITTER $670-62 $1.874-94 Training Admin 1 Dues Travel Savings Other Tonal � Fr=rtges Sub r7etlucl. 0 0.00 0.00 O.DD 0.00 0.00 0.00 O.Do 0.00 $0.00 $4,00 50-00 $0.00 $0.00 50-00 $7-40 $534-50 Other Deduction Notes: Training Fee 8 = STRAMHT TIME -OTHER - Any other deductions ewb ihaiom anuror payments wtrether or na= ncluded or required by prc"ing wage deter ninalbM last be seParxlelf W0d. CERTIFICATION MUST be oom*led Fenn A-1-19t (New 2�0} 0 = OVEJMME Use exUa sheegs) if necessary. (See reverse sade) 0 = 00U6LF71ME SOI = STATE DISAOLJTY INSURANCE" cammis 0epa►lmeo=of 2024 Heber[ Walkup Pipeline Replacement) Herbert Walkup Pipeline InduMfialRallati°ns PUBLIC WORKS PAYROLL REPORTING FORM I Page A of � (1) (2) (3) (4) DAY (5) (6) ry (S } NAME.ADORESS Y r AND SOCIAL o �o c WORK I Dale HOUFtL NET SECURITY NUMBER OF EMPLOYEE dR �- CLASS- =3w I IFICATION &1$ + W19 + 8120 18A21 ! 9122 803 18124 TOTAL i'iOURS Y RATE OF! PAY GROSS AMOUNT EARNED WAGES DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID CHECK FOR Hours Worked Each Day WEEK I S 0.DO Q.OD 8.00 0,00 D-DO 0,00 0,W 800 S94.64 THIS ALL Federal PROJECT PROJECTS Tax FICA & Medicare State Tax SDI Vacation Health 8 Fermi TAYLOR, KRISTOPHER I Operating Holiday Welfare 19730 Forest View I Engineer 1 (Heavy & 0 0.00 0.00 0.00 0.00 $125.2 S603.00 $312,59 $330.57 $44.95 $0.00 $0.00 SO.00 Circle Pioneer CA (Highway 0,00 D.00 0.00 000 1 Rion work} 1 IGroop3Area1 $757,12 $4,115.67 Training Admit 1 Dues Travel & 52 795.0B D1L1 Tolar Savings Qther I Fringes Sub ❑eclat[. D 0,00 O 0.0.DQ 0.00 O.f10 0.00 0.00 4.00 0.00 $0.00 $9.68 $0.00 S0.00 $0.00 51,320.5 S0.00 $29.48 9 r Other Deduction Notes' T ini. S "D D 8.00 0.00 0.00 0.00 8.00 0.00 16.00 560.00 ��.� nLL IrtlOWdi PROJECT PROJECTS Tax FIL;A d Medicare Mate Tax - SDI vacation Heath & ^ I Pension TAYLpR, I Holiday Welfare KRISTOPHF..R PLUMBERA I 19730 Forest View UNDERGROU $W3-00 $312.59 S330.57 $44.96 50.00 $0.00 $0.00 Clyde Pioneer CA 1 I ND UTILITY 0 4.OD 2.00 2,DO 0-00 0.00 0.00 D-W 4.00 S60.45 95666 PIPEFITTER J 51,281.60 $4,115.57 TrairNng Adraln I �� Travel & $2 795-08 DID Savings other I Fringes Sad �dTota� D 0.00 0.00 0.00 0.00 0.00 0.0o 0-00 0.00 $0.00 $8.00 SOOD $0.00 S0.00 $1.duct- $0.00 $29.48 9 I - Other Deduction Notes Tr in n S 0-00 8.00 8.00 0.00 8.00 8- 0 0.W 32.00 SW-64 THIS ALL Federal PROJECT PROJECTS Tax FICA 8 Medicare State Tax SDI Vacation Health & l Pension ViNC1GDERRA, I Holiday Welfare AUSTIN Operating 330 Bodega Court El I Engineer 2 (Heavy & 0 0.00 2.00 2-DO 0.00 2.00 $132.7 E818.0D Wl-79 5449.85 $57.70 S0.00 $0.00 $0.00 Hills CA I 2.00 D.00 8.00 92 Highway work) 1 I Group 3 Area 1 1 $4,250-16 $5,312.70 Training Admit f Dues Trave! & $3,464.78 00 Total Savir�s Sher I Fringes Sub Dedua D o.00 o.a0 0.0o D.00 0.0o v.oa o.00 0.00 $o.oD W.40 $0.00 $0.00 $1,8a7.9' SO.00 50_00 $60.60 2 Other Dedudlon Notes: Training lee VINCIGUERRA S "DI D 8.00 0.00 0.00 0.00 0.00 O.DO 8.00 M-64 THIS ALL Federal PROJECT PROJECTS Tax FICA& Medicare State Tax SDI Vacation Health& Holiday Welfare P6ri`'ron CASEY I Operating 470 Broadmeadows I Engineer 5132.7 S808.00 $.326-93 $343.65 $47.01 $0-00 $0.00 SO.00 Court Sutler Greek 4 (Heavy & (Highway 0 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 work] 1 Group 3 Area 1 1 $797.12 $4.31T16 Training °dn4" r Hues Travel & $2.948.01 DAD 8avin s Other Tom 9 Fringes Sub DeducL D 0.00 MOO 0.00 0.00 0.00 0.00 0.00 0.00 $0,00 I $9.66 $0.00 $0.00 50.00 51,389.1 50.00 $43.56 5 Other Deduction Notes Irarr ing fee. Cal Savers Farm Rr1-13l [New z�I 5 - STRAIGHT TIME OVERTIME 0Use 'OTHER -Airy atlrer der�chans, aonh ttiarYs andrar payments wtwdh f or nor ed--ded or required try prevailing wage dowminatiorrs molar be separo,ely Iisiee. CERTIRCATION MU41; be c letea extra sheel(s) it may, P D = DIX16iETIME (See rmerse side) SDI - STATE DISABILITY INSURANCE California 2024 Herbert WalkupPipeline Replacement I Herbert Walkup Pipeline Department ofCAR P Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page aof6 (1) (2) l (3) (4) DAY (5) (6) [$} (9) 1 S I M I T I W I T I F I S NAME,AOORESS 2'a1 NET WORK AND SOCIAL aqs 1 CWSS- Date TOTAL v GROSS AMOUNT DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID HOURL S CHECK SEC URITY NUMBER 6xt I lFlCASl 8118I W191 8120 18121 I W22 I B123 I "4 HOURS OF PAY EARNED FOR NO. OF EMPLOYEE W I WEEK Hours Worked Each Day I THIS ALL Federal FICA& Stale Vacation Health8 I S 0.00 8.00 0.00 0,00 8.00 8.00 0.00 24.00 $53.61 PROJECT PROJECTS Tax Medicare Tax SDi Holiday Welfare Pension WILLSON,SLOAN I PLUMBER/ S421.00 $204.64 S189.16 $29.43 $0.00 $0.00 SOO) 3020 Newton Road. I UNDEtRGIROU Sp. 1 Placerville CA 5 ND UTILITY a 0A0 1.60 0.00 0,00 1.00 1.00 0,00 3.50 570.I"Ndrrrlrt 1 Travel $ Total 87 S1 721.44 DIO � PIPEFITTER _ $1,534.69 $2,590,25 Training Fringes Dues Sub Savmgs Other Deduct D 0,00 D0 0.00 0.00 0 .00 0,00 0.0.00 000 $0.00 S11-00 50A0 $0.00 $0.00 $0,00 $130.56 $968.81 I Otho Deduction Notes: Trainiag fee. Garnishment rum rvx,erai riw, a orate S01 Vacation Health & J S 0.00 8.00 U-00 8.00 8.00 B.00 0.00 40.00 $99-64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare Pension YOUNG JIM I Operating $914.00 $406.82 $459,62 $58,50 50-00 so DO 30.00 P. q. Box 58 I Engineer 1 $132.7 1 (Heavy & 0 0.00 2.00 2.00 1,50 2.0D 0 00 O.DO 7,50 S3J56.27 DID Ffdd 95fi29 1Highway wmric)1 1 & Total Group 3 Area 1 &4,950.93 $5,379.06 Training Dues puss Adinnini T Sub Savings Other p d L 0 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 $0.00 $22222,7 I $s7.aa $a.oD �a.DD so.oD sa.ao 53s3.85 9 Other Deduction Notes: -training le$. Cal Savers l THIS ALL Federal FICA & State Vacador. Heallit & 1 S D.30 8,00 8,00 8,00 O-DO 0,00 0,00 24,00 $53.61 PROJECT PROJECTS Tax Medicare Tax SDI Ha day Welfare Pension ZEL.L.ERS. JEREMY I PLUMBER! 5192.DC $147-95 S110.40 $21,27 50.00 $0-00 $0.00 8194 MAIN ST 1 UNDERGROU MOKELUMNE HILL 0 NO UTILITY C 0,00 1.00 3.50 ODD 0.00 0.00 0.00- 1.50 MAT Total Si 321.3E DID 1 PIPEFITTER $1.392.955 $1,944.20 Training Fringes s Dues Travel& Savings Other edu Fringes Sub Deduct. 1 D ODO 0,00 0,00 100 0.00 0,00 0.00 C-00 $100 $1020 $0.00 $0.00 SO.00 50,00 $151.20 $622,82 Other Deduction Notes: Training fee. Cxamishmeht S = STRAIGHT TIME •OTHER - Any other dad,ctiona, ❑❑ntribLICOM anof❑r payments atwt►ier or nal Induftd or nKUire4 by prevadtg wage descrminabonc must be separately listed. CERTIFICATION MLM ba oorn* Form {s-1-731 (New 2�p} a - OVERTIME Use �a she"Sj if neCessary. (See reverse side) 1)= DOUBLETI)JE SD1= STATE OISMUTY INSURANCE California Department of Industrial Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOR f SUBCONTRACTOR Vinciguerra Construction, Inc. FIRST DAY AND DATE OF PAY PERIOD 131180024 I do hereby certify under penalty of perjury: 2024 Herbert Walkup Pipeline Replacementf Herbert Walkup r'ipe€ine PUBLIC WORKS PAYROLL REPORTING FORM Page 5of6 CONTRACT NUMBER Herbert Walkup Pipeline I LAST DAY AND DATE OF PAY PERIOD 1 8124i'2Q24 1 (1) That I pay or supervise payment to employees of the above -referenced contractor on the above --referenced contract. AI€ 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 8R;Kified in the applicable wage determination incorporated into the contract; N IKI 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) !I Have been or wil I be paid to the approved plan (s), funds(s), or programs) for the benefit of listed employee($): except as noted below. N M Have been paid directly to the listed employee(s), except as noted below. (c) MSee exceptiflns noted below. - - EXCEPTION CRAFT EXPLANATION REMARKS: Except for Training funds for all crafts paid directly to CAC. NAME (PLEASE PRINT.) R { TITLE �� iVSTI Y � { G� , ti/ � � Vovmlmw SIGNATURE. I DATE 911712024 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 Copelana Act, {40 U. S. C. 275c). Also, the willful falsification of any of the above statements may su bpect the contractor or subcontractor to civil or criminal prosecution (See section 1001 of title 18 and section 3729 of tide 31 of the United States Code). ADA Notice For inclMduals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6414 or TDD (916) 654-3880 or write Records and Forms GEM 2503 Management, 1120 N Street, MS--89, Sacramento, CA 95814. Dp 2024 Herbert Walkup Pipeline Replacement I Herbert Walkup Pipeline Deepartmeant of 4rinart tndustrialRela&!Qns PUBLIC WORKS PAYROLL REPORTING FORM Page 1 of.Q 1 NAME OF CONTRACTOR: Vinciguerra CoNstruction, Inc. CONTRACTOR'S LICENSE NO.. 358838 ADDRESS P. O. Box 157, Sutter Creek, CA, 9W85 JOR SUBCONTRACTOR: SPECIALTY LICENSE NO.: =YROLL NO_ FOR WEEK ENDING: +SELF-{NStlRZ p CERT: i PROJECT OR CONTRACT NQ.: Herbert Walkup Pipeline 2t 4412M V104RITRS COMP: (PROJECT AND LOCATION:20fAHerbert Walkup Pipeline Replacement, ELD (i) (2) ; 1a1 (4)DAY (6) (6) (7) [81 (9y NAME. ADDRESS AND SOCIAL 9' J WORT{ Date TOTAL IiR GROSS AMOUNT NET WAGES CHECK SECURITY NUMBER d-? 1FICA 8r25+8I26l8127I8I28 8128 a130I8J31 "O""s RATE dFAAY EARNED DEbL'CTpONS CLZNTRIBli71QY8ANOPAYMENTS PAR No. OF EMPLOYEE WEEK I Hours Worked Each Day i THIS ALL Federal FICA& State $DI Vacation Healm& Pension J 5 0.00 4.00 4.00 4.OD 4.00 4.00 010 20.00 $94.64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN, TMCHIAS ( Operating - S690.W $271.50 S281.71 $39,04 SOA0 S0,00 $0.00 12650 C Engineer $125.2 en Shandoah Rand 0 � (Heavy 8 O 0.00 0.00 0.00 0.00 0,00 0.00 U.00 0,00 1 $1,528.97 DID 9W9 Highway work} 1 $1.892.80 $3.5$4.13ti Training Admin 1 Dues,Travel & Total Savings [](her Group 3 Area 1 Fringessub Deduct r Lw. U.w v_w u.w V.UU U.W 0.00 ... 000 OOD 3000 $24.24 50.00 $0.00 50.00 � �•D9I $373.44 $1.655. 9� 9 Other Deduction Notes: Training fee GamishmInt THIS ALL Federal FICA & State SDI Vacation Heatth & Pension j S 0,00 4,00 4-00 4.iDD 4-0t1 3.00 0.00 19.D0 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN, THOMAS 12B50C J PLUMBER) J 56W-00 $271.50 S281-71 $39-04 S6.00 $0-00 $0-00 Shenandoah Road 0 UNOERGROU ND UTILITY O 0.00 150 2.D0 2.00 2-OEl 0.00 0.00 7-50 570.87 S1 928.97 DID � PIPEFITTERt S1A5,W.12 V.SS4.66 Training AdminI Fringes ¢ Travel& Sub Sayings Other Total Deduct, D J 0.00 0.00 0,00 0.00 0_00 0.00 0.00 0,00 $0.00 S10.60 50-00 so DO 50.00 S16556 S0.00 5373.44 ..9 Other DedKtk>n Notes: Training fee. Garrishmerrt THIS ALL Federal FICAB Stale SPI Vacation Health & Pension J S 0.00 D.DO 0.00 0.00 0.00 8.00 0.00 8,00 $53,61 PROJECT PROJEC75 Tax Medicare Tart Hdiday Welfare GABREE. PAUL ' PLUMBER 1 S208,00 $181.12 5151.71 $2B.04 $0.00 $0,00 S0.00 611 Glentxnpk Drive 3 UNDERGROU O 0.00 0.00 0.00 0.00 0,00 1.50 0.00 1,50 $70.87 S1,8.67 DID 00Adrnin! J NDUTILITY Travel Total J PIPEFITTER $535-19 $2.371.34 Training Fringes Dues Sub Savirigs Other Deduct, D 0,00 0,00 0.00 0.00 0-00 0.00 0.00 0.00 $010 $3.80 $0.00 $0.00 SO -OD $0.00 $3.80 j570.67 Other Oeductiom Notes. Training tee 3= 5TR4k3H1I` TIME 'OTHER -Arty other ded-xt". andlor payments whether or not Oduded Or requi rod by prevedrg wage tlCtern:ilati0r15 must be sepesaWy wsree- CERTIRCATION MIST ee-X-pieted Form A--1-131 thaw 240) 0= O0i WIRTI E use extra sheeusj ,r ^,. cas&ary. (See reverse side I 501 = STATE DISABILITY INSURANCE Calitorma 2024 Herbert Walkup Pipeline RepL"ment 1 Herbert Walkup PipeMe �� Department of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM pap 2Orz (1) (2) rl (3) (4) DAY (7) I8i (9) I SfTIWITfFIS NET NAME.ADDRI:SS AND SOCIAL V" l a°_ I WORT( CLASS - Date TOTAL y �RL CR05S AMOUNT pE1761CT10NS. QONTROUTIONS EARNED AND PAYMENTS WAGES CHECK PAID Na SECURITY NUMBER 61w I IFICATION W25 I Sf26 18127 1 SY28 I " 18130 a131 Or PAY FOR OF EMPLOYEE �� WEEK I Nrxrrs Worked Eat Day , THIS ALL Federal FICA & State SDI Vacation Health 8 Pension S 0.00 6.00 8,00 8.00 8.00 7.50 fl_00 39.60 $53-61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GARIBADI, [ PLUMBER! S529.00 $220.68 $212-96 $31-66 $0.00 $0.00 50-00 ANTHONY P.O. Box 905 Suttef 0 UNDERGROU O 0•OD 1-50 2.00 2,00 2.p0 0.00 ODD 7.50 S70.8T S7,883.28 DdD B6 ' NO UTILITY PIPSFITTER !ramie 1 Travel & $2,649.13 $2,897.17 Training Frtrlges Does $uh Total Savings Other Deduct. D GJDD 0.00 0,00 0.00 0,00 0-00 0.00 0,00 $0.00 318.80 $00) -S0.00 S0.00 SO.00 $20.20 $1,013.9 9 Other Deduction dotes: Trainina fee t^eaerai "A W - .tea o SDI � HeaBh & P+3rt�iOn J S DiDD 8.00 8,00 8A0 8.00 TM 0.00 38.50 $59-61 PROJECT PROJECTS Tax Medeare Tax tlolitlay We#are _ GIRARDIN, FLOYD I PLUM13ER1 -- $5%-00 $225A8 $217.12 SM.43 SQ.00 $0.00 $0.00 P_ O. Box 102 Rlver T UNDERGROU O 0.00 2_DD 2.00 2.00 2.00 OVI) 0.00 8.00 $70.$7 - 51.966.41 DID NO UTILITY PIPEFITTER $2.684.56 $2.9fi8.0�1 7raming Fn 71 l7YfS T Sub sevirgs deduct D 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0-00 $O-00 $19.00 50.00.00 9D O0 50.00 $1.OD7.6 1:20. •, 3 - Other Dedudiwl Notes: Trainingfae l THIS ALL Federal FICA& Stale SDI Vacation :ieafth & Pension I S 0.00 0.60 0.00 0.00 0.00 7,60 0-00 7.54 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GRIEGO. DAVID I PtUMBERJ S296.D0 $157.54 S129.30 $22,55 SO. OD $0.00 $D.00 1730 Rock Springs Road Escatdido CA 1 UNDERGROU a O 0,00 0.00 0.00 0.00000 0.00 0.00 0.00 $70,87 S1 453 73 DID ND UTILITY ( PIPEFITFER $z02A8 $2,086.02 Training Admin 1 Ftirlges Dues Travel & Sub Savings Total Otter Dedt.ct 0 0.00 0.00 0,00 0.08 0.00 C-00 0-00 0.00- $0.00 $3_DC $0,00 $0.00 $0.00 $0.0D $6-80 S61Z.29 Other Deduction NNes: Trainirra foe THIS ALL Federal FICA & $We SDI Vacation FIeaI1h & Pension I S 0,00 8.00 B.00 B.00 8.00 B.00 0.00 38.00 S53.61 PROJECT PROJECTS Tax MedrOare Tax webre MERCIER. I BRANDON Pl. UM8ER1 $469,W $216.06 S205-35 $31.16 $1100 $0.00 SO-00 40C Cragmont Court 1 UNDERGROU O 0-OO 2.00 2.CC 2.00 2.00 Q.QO 0,00 e.UO 570.87 51.910,2Q DID Cameron Park CA ND UTILITY I $3.684.14 $2.852.19 Training Adrnin I Fringes Dues Travel 8 Sub Savrgs TOWPIPEFITTER Otter Deduct. 0 0.00 0.00 3-00 0.00 0.00 0,00 0.00 0.00 Sa.00 sla.ao $0.00 $000 sa.oD SD.aQ $19.80 $941.99 Other Deduction Nat@S. Tramino lee 5 = STRAIGHT TIME `OTHER - Fury ni?o r deductions. can rioulions andro payments wbBther or M4 i1duded or reGured ay prew8ifn9 wage derermnat ons must be sepamlely hsted. CERTIFICATION MUST be oompkaed 0 = OVOTFIME use exua srreeo s) d rreGawary. (See reverse side) Form A-1-131 [New 2-91 D e OOUBLETIME SDI = STATE DISABILITY INSURANCE CaliforniaJ01 2024 Herbert Walkup Pipeline Replacement) Herbert Walkup Pipeline De epartmeartmnt of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Pageaaf6 (1l (2) l (3) (4) DAY` 05j i6 (7; (a) {�] S MITIWITIFIS NAME, AOORESS AND SOCIAL x ofs o WORKHOURL j Dit TOTAL Y GROSS AMOUNT OELIUCTIONS. CONTROUMNS AND PAYMENTS NET PAIDS CHECK R SEOr x; CiAS5 IFICATION arm I fl m 18127 _ I &W I Imm I stag I ml HOURS OF PAY EARNED NO. EMPLOYEE i WFOR EEP{ Flours Worked Each Day II THIS ALL Federal FICA & State SDI Vacatiar Health & Pension S 0.00 8.00 8.00 8.00I 800 650 000 38.50 $53.61 PROJECT PROJECTS Tax Medicare Tax Holiday Wetfare FASTEN I VELAS4UEZ, PLUMBER! S211.00 SW2.54 5180.35 $29.12 $0.00 $0-DG 80.00 E"Sto D UNDERGROU D•0.001.OD 2.UQ 1.50 2.00 0.00 O.t70 fi,50 37p.87 52.024,58 Ulq 742 EsC1Yn Or 95776 j ND UTILITY PIPEFITTER $2,524.65 $2,666.39 Training F�� Dues 'T Subravel& Savings 091er Total Deduct. DI 0.00 0.00 0.00 O.OD 0.00 0.n0 0.00 0.00 $0.00 S18A0 0.00 $0.00 S0.00 $0.00 $1aX0 $641.81 - -- Other Deduction Notes Training fee -- � -r;ra -►" re0aral FICA3 Stale SDI Vacation Health 8 Pension - - E S 0.00 DM 8" $.W ODD BAD 0.00 32.00 $60.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare PE.REZ SERGIO � PLUMBER 1 I S629.00 $258.32 S261.04 $37.15 SO.00 $0.00 SO.DO 149 Oak Ridge Drive 1 UNDERGROU O ODD 0.00 2.00 2.00 2.OD 2.00 0A0 8.00 $00.45 $2 191.22 DID lone NO UTILITY PIPEFITTER 563 i2,.60 $3,994.73 Training A1 Dues Travel & Savings Other Total � Fringes Sub Deduct D 0.00 0.00 0,00 O.DO D-DO 0-00 ODD 0.00 SO -OD $16.00 $0.00 $0.00 50-00 SO.CQ $18.30 51,203.5 Other Deduction Notes Training fee THIS ALL Federal FICA & State Sol Vacation Vacation Health & Pardon S 0-00 $.D0 8.00 &OD 8-00 6.0a 0-00 3$-00 594.64 PROJECT PROJECTS Tax Lr+e Mdlca Tax Welfare TAYLOR. KRISTOPHER Operating Engineer $873.00 $400.15 5447A4 S57.54 $0.00 $0.00 $0.00 19730 Forest View 1 (Heavy 8 O 0.00 t,OQ 2.00 1.40 1-UQ D.00 0.00 5.00 $125.2 g3,452.24 Dip Girdle Pioneer CA W8fi - Highway work) f 1 Group 3 Area 1 1 54222-37 $5,288.DD Training Frjn1 rtYBES Dues Tray Subb Savings Other Data) Deduct. D 0.00 0,00 .00 O0,00 0.00 0.00 ❑.00 coo $0 OO S52.03 SD.iICI $0,00 50.00 $0-00 $57.43 � 8 Other Deduction Notes Traini l THIS ALL Federal FICA & State SDI Varatior Health & Pension f S O.GO 0.00 0.00 0.00 0.00 0.00 0.00 D.00 $94-64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare TAYLOR. KRISTOPHER PLUMBER 1 I U-00 $0.00 $D.DD SO.00 $0.DO $0.0u SO-00 19730 Forest View UNOERGROU D 0-00 0.00 0.00 0.00 O.OD 0-00 0.00 0.00 $125.2 SO 00 Circle Piwieer CA NDILI UTTY ] pfPEFITTJZ 1 $0.03 50.00 TrainiM] Admin 1 Fringes D1Ls Travel & sub Savings Omer TOM Deduct- D 0.00 0.00 0.00 0.00 0.00 0.00 ❑ DO 0.00 $0.09 $0.00 SD.aO $0.00 50.0D $0.00 $0-00 50.00 Other Deduction Notes; Training S = STRAIGHT TIME 'OTHER - Any other dedLcl'mns nontribtRJarrs andlor payments whetrer car not odWed or required by preva&,g wage dekyrninetiats fm w W m"ratety lined. CER7IFICATI0Q kjQt jT be completed 0 = OVERTIME use C- L" stmags) if rw^ Crary- {See revefae side Fc m A-1-131 (Now 2-4�0) 0 = GOUBLE11 ME SO[ - STATE DISABILITY INSURANCE California 2024 Hurt Walkup Pipeline Replacement I Herbert Walkup Pipeline 40:1 lDepartmentot Industrial ReMons PUBLIC WORMS PAYROLL REPORTING FORMA Page 4 of 6 - M (2) I (3) (4) DAY 51 f6j (7) (8) (9) I 22I 5IMITIWITIF(5 - NET NAME, ADDRESS AND SOCIAL Dov I WORK CLA Dale TOTAL H°Lf'� V RATE HOURL GROSS AMOUNT EARNED QFl]UCTIONS, WAGES CHECK CONTR[6UTIONS AND PAYMENTSPAID SECURITY NUMBER S I IFIAS 0 &125 I a126 + 8+27 1 8128 1 8r29 I WO f 11*1 OFNO OF PAY OF EMPLOYEE �, WEEKHours I Worked Each Day THIS ALL Federal FICA & State SDI Vacador Health & Pension S 0.00 0.00 0.00 000 0.00 2.00 0,00 2.00 S50.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare TAYLOR, I KRISTOPHER PLUMBER1 $873,00 $400.15 $447.64 $57.54 $0.D0 $0.00 S4.0D 19730 Forest View I UNDERGROiJ t O 0.00 100 0.04 1.01D 1.00 0.50 0.00 3.50 $80.45 $3 452.24 DID Circle Pioneer CA NO UTILITY PIPEFITTER I _ $401-58 $5.288.00 Trainng Fringes Dues T Sub & Savings Total Other DeducL D 0.00 0.00 0.00 0 DO 0.00 0 00 0.00 J 0.00 $0,00 $2.20 50.OU $O.OD $U-04 80.D0 S7,835. $S7 d3 6 - Oltmr Deduction Note-.' Trauning -ArL I-ederal FICA & stiife SDI Vacation Health & - - Pt 1&taat S QM 8.00 8.00 OM 0.00 &DD 0-00 24.00 $99.64 PROJECT PROJECTS Tax Moducare Tax Holiday Welfare VINCIGUERRA. I O ratin AUS"Tlh! I Engineer r S783.00' $311-62 S409.49 953.43 $0-00 $000 $0.00 330 Bodega Court 2 [Heavy & 0 0-00 1_D0 2.00 0-00 0.00 0-rxr D.OQ 3.p0 5132 7 $3 240.! 6 DIo Dorado Hails CA 957fi Itiighway waxy 1 I $2,789-49 $4.914.57 Training Admin I Fringes Dues Travel & Bun Savings Total Other Deduct. j Gmup 3 Area 1 I ❑ 0,00 0-00 0.00 0.00 0,00 0.00 D.00 4-DO $0.00 $32.67 $0.00 $0.00 $0.00 SO-00 $56.87 S1,674.4 1 - Other Dedudion Notes. Train rig foe THIS ALL federal FICA & State Sol Vacation Health 8 Per�Sion I S 0-00 8.00 0-00 0.00 O.DO 0.00 0,00 9.OD $99,64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare VINCIGUERiiA, CASEY IOpera 5487.00 $284.69 5287.15 $40.94 $0.pp $0.08 $0.ty0 470 Broadmeadows � Engineer Engineer 4 {heavy 8 O 0.00 0.00 0,00 0.EI0 O.Oq 0.00 0.OQ LJ.00 $132.7 - 52.621.58 DID Court Sutter Creek IHi Highway work] 1 Group 1 $797.12 i3:752.a2 Training Adu in I Fringes Dues Travel a Sub Savings Total Other Deduct. I 3 Area 1 I D 0.00 0.00 0.00 000 0.00 0.00 0.00 0.00 $0.00 $9-66 50.00 $0-00 $0.00 SO.00 $31A6 $1,131.2 4 _ - Other Deduction Notes: Trainina fee. Cal Savers THIS ALL Federal FICA 6 State SDI Vacation Health & P". ion S 0.00 8.00 8.00 8.00 8.00 6.50 0.00 38.50- $53-61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare WILLSON. SLOAN J PLUMBER1 $41C00 $202.54 S180.35 $29.12 s0-00 SO-00 SO.00 3020 Newton Road, I URDERGROU Sp. I Placerville CA 5 ND UTILITY I O 0.00 1.50 2.00 2.00 2-00 0.00 0.00 7.50 $70.97 Adminl Travel& S1.706.20 DID Tntaf B5Ffi= I PlPEF1TTER 665 $2.595.52 E2,.39 Training Fringes Dues Sub Savirxas Other Dedud. I D 0.00 0.00 D-00 0.00 0.00 0.00 0.00 0.00 $0.00 $18.40 $0.00 SO.00 $0.00 $0.00 5734-18 $960.19 Other Dt d uetlon Notes= Tmi4no fee. G hment 6 - STRAIGHT -nME "OTHER - Ivry other aeouclionr. ConUAxAi( ne OFO(W paym fws wrwu*r or not Adudw or WLjred by pmvadmg wage determinations inusi be- Separa ft "W. CERTIFICATION MUST be compleiea Farm +4-4-t37 (N�r 2-eel 0 OVERTIME use on" she"s) if necelsorry. iSne rawerm s ne} 000BLFTIt.1E Sol - STATE OI SABIL 17Y WSURANCE nia 17eparK of Dme epartme 2024 Herbert Walkup Pipeline Repfacemerd 1 Herbert Walkup Pipeline lndustrialRelations PUBLIC WORKS PAYROLL REPORTING FORM paye,�Qff2 (1) (2) 1 (3) (4) DAY {5} 16) (7) {S) (9] S I M I T I W I T I F I S NAME. ADDRESS AND SOCIAL "i I 'to WORK Stir Dade I RL NET SECL)RITY NUMBER CLASS- i= fFICJITION 8l25 I ails 8l27 I Sf28 18129 18f30 I TOTAL HOURS ',Y RATE GROSS AMOU NT EARNED DEDUCTIONS. CONTRIBUTIONS AND PAYMENTS WAGES PAI❑ CHECat OF EMPLOYEE 3 i $r31 of PAY FOR NO. Hours Worked Each Day WEEK S 0.00 8.00 $.OQ 8.00 8.00 8.0D 0.00 40.00 5$9.64 THIS ALL Federal FICA & State 5D1 PROJECT PROJECTS Vacation HIM" & pension Tax Hledkare Tax Holiday Welfare YOUNG, JIM Oporati"g P. O, Box 56 Engineer $732f 98W.00 S391.73 S439.45 $56,33 $0.00 $0.00 50.00 95629 1 I (Heavy R O O,W 1.00 2.00 2.00 2.00 0_ilO 0.00 U0 53,45[i_39 DIO �.F Highway work] ! Group 3 Area 1 4,91d.57 S5,i79.9A' Trakting AdngDues Tray Sa O� Total �p Fn"t3m Sub DeducL 4 0.00 0.00 0.00 0.00 0.00 0,40 0.00 0.00 $0,00 SSr -97 SO_00 SOAO $0.00 $0.00 $370.09 S2.123.6 0 Other Dedue on 1lates' Trainnn fry rml SavFvA S STRAIGHT O = OVERTIME FINE aTHER—Amy oviBrdeduc[iona, oordrltxAirns enaror p wr�edterw not i'Kfuided or required by premin9 �9edelemi nations Host be wpere" k*d_ CERWVAT10N �MJST 6e completed rum ,fit—t31 {New 2�BOj 0 = DOUBLETIME Use extra sh KS) irnecessary- { See reverse side) SDI = STATE DISABKJTY INSURANCE cal numia Department of Idsnettria! Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE (CONTRACTORfSUgCONTRACTOR Vinciguerra Construction, Inc. FIRST DAY AND DATE 4F PAY PERIOD 812512024 1 do hereby certify under penalty of perjury: 2024 Herbert Walkup Pipeline Replacement Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM Page 6 of 6 CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD W3112024 (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—refererced time period have been paid th a!r 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 beets made either directly of indirectly from the lull wages earned by any person other than permissible deduetlons. (2) That this employer has complied with the requirements of the California Labor Code Sections. 1771, 1611, 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 oat less that the applicable wages rates: (a} 5pecitied in the applicable wage determination incorporated into the contract; (b) Determined by the Director of Industrial Refations 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) FlHave been or will be paid to the approved plans), funds(s), or program(s) for the benefit of listed employee(s), except as noted below. (b) 0 Have been paid directly to the listed employees), except as noted below. (c) See exceptions noted below. I EXCEPTION CRAFT EXPLANATION REMARKS: Except for Training funds for all crafts paid directlyto GAG. NAME (PLEASE PRINT.) � _ TLE /� V�ii�i V I t# C r �{ L/f�¢77►� � + ir"Y.G?!�''�� SIGNATURE. ,J DATE 1OW024 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 Gape land Act, (40 U. S. C. 276c). Also, the wi9lful IJ Ws fication of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (See section 1001 of tide 18 and section 3729 of title 31 of the United States Code). } ADA Notice For individuals with sensory disabilities, this document is available in altemate formats. For information call (916) 654-6410 cr TD0 (916) 654-388C or write Records and Forts 3 Management, 1120 N Street, MS-89, Sacramento, CA 95814. 2624 Herbert YValkup Pipeline Replacement 1 Herber[ Walkup Pipeline Eaeparrrn t7epartmeei of Industriall4ela4ons PUBLIC WORKS PAYROLL REPORTING FORM Page 1of5 I NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S f.ICENSE NO.: 358838 ADDRESS f - 0. Box 157, Sutter Creek, CA, 95685 J OR SUBCONTRACTOR: SPECIALTY LICENSE NO.: I PAYROLL NO. I FOR WEEK ENDING: SELF -INSURED CERT: PROJECT OR CONTRACT NO.: Herbert Walk Plp+elli I 22 1i W712024 WOWEERS COMP: PROJECT AND LOCATION:2024HwbedThA oupPipeIIno Re piacerne rot, ELD (1) (2) t (3) (4)DAY (5) (B) (7) (8) (9) I $ I M I T I W I T I IF 15 NET NAME. ADDRESS AND SMAL i WORK o ,�'a I CLASS- :Sate TCOTA4 HOURL Y RATE GROSS AMOUNT DEDUCTIONS. CONMIBUTIONS AND PAYMENTS WAGES CHECK PAID UMBER SELF ` IFlCA710N 9101 I W02 19l03 19104 19M 19M 19107 HOURS OF FAY EARNED FOR NO, EITY PNO E w i HtEE1t Hoerr Worked Each Day I I THIS ALL Federal FICA & State 50i Vacation Health & Pension S 0.00 0.00 4.00 4.00 4.00 0.00 ODD 12.W SM-64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN. THO M1AS I Operating �� M $208.39 S194.64 529.67 SD_t70 $0.00 $0.00 12650 C Shenandoah Road � Engineer 0 (Haavy & 0 0.00 0.00 0.00 0,00 0.00 0.00 0•DD 0.00 5125.2 11 $1,443.34 wD 5669 Highwaywtxk}( --ram S1,135_6a $2.725-44 Training Adman t Dues Travel & 5uG Total Savings Other Deduct Group 3 Area 1 Fringes -��OII �W �� 6b 0.00 0.00 0.U0 i0.da 574.�52 50.00 50.00 SU.00 SO-00$n5.40j$1,282-1 1-a Ce,er Deduction Notes: Trainingfee Garnishment l THIS ALL Federal FICA & State SDt Vacation Health 8 Pension j S 0.00 0.00 4,00 4.00 4.00 0.00 0- 0 12.00 553.61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare COWAN. THOMAS I PLUMBER/ 5485-00 $20629 S194.64 $29.67 50.00 $0.00 50-00 12650C Shenandoah Road I UNDERGROU 0 O O.OQ 0.{30 2.00 2.C)0 150 OAO Q.00 5.5U $70.87 51,d43 3d DAD �9 I PI UTILITY PIPEFITFEf2 } ii $1,033.11 $2,725.44 Training Adman 1 Fringes Domes Travel & Sub Total Savrrgs abet Deduct 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $7.00 SO-00 $0.00 SOLD SO.00 $365.40 $1,282.1 0 Other Deduction Notes: 1mirlintlfeu: I,:%michment l THIS ALL Federal PICA P, Stake SDI vacation rfeallh & Pension S 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $53.81 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare GASRE✓w, PAUL I PLUMBER) $203.00 $177,93 $147.44 $25.58 SO.00 50.00 SO-00 611 0enbrock Driva I UNDERGROU 3 O a.aa O.OD 0.Q0 2.00 0.00 0.00 Q[l0 2.00 570.87 $7,771.87 OID 4 I ND UTILITY PIPEFITTER $570.82 S2,330.22 Traytmg Adman / Fringes Dues Tr-avel8 Sub Total Savings C+ther Dedud- i D 0.00 0.00 O.Oa 0,00 0.00 0.00 0.00 0.00 $0-00 $4.00 5Q.00 $0.00 50.00 $0.00 $4.40 S558.35 4?iiler Deduction Notes: Trainino fee 5 = STRAIGHT TIME -OTRER - Any alr r 6eCuctinns. contnbubom a"d payments whethes or not included or required by Xevaitirrg wage eeterminabons must be zewrsi* lisle& CERTIFICATION FAl �7i^ ba mmpieled 0 e OVERTIME use exva shW(s) rf neoorsary. [see reverse side] Form A-1-131 (New 2-Q) 0 = DOMLE 1ME SDI = STATE OISAMLITY INSURANCE California 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline �� ❑epartrnent of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 2of5 (1) (2) 1 (3) (4) DAY (7) I SIMITIWITIFIS NAME. ADDRESS AND SOCIAL 3 i I a i WORK CLASS-IFICATd Date TOTAL YHRATE GROSSAMOUNT DEOUCTFONS,CONTRIBUTIONS AND PAYMENTS WAGES PAID CHECK NO. SECURFTYNUMt3ER x4$ 9 I I9102I9103I91'04IW0510*6I9d07 HOURS OF PAY F14ftNED FOR OF EMPLOYEE #. I WEEK Flouts Worked Each Day _ THIS ALLFederal FICA 8 State S01 Vacation Health 6 Pension S 0,00 0.00800 0.00 5.00 0.00 0.00 13.00 M-61 PROJECT PROJECTS Tax mediwre Tax Holiday Welfare GARIBALDI, PLLJM13ER 1 $238-00 $124,54 585.18 $1 7.91 50.00 40.00 50.00 ANTHONY P- O. Box 985 Sutter UNQERGROtJ 0 0.00 O.00 2,00 0.00 4.4p 0.00 0.00 2,00 $70.67 51 16e.28 D!❑ ND UTILITY PIPEFITTER -- 3838.67 $1,1i34.11 7rdining Adrrun ! Fring�S Dues Travel 6 Sub Savings Other Total Deduct D 0.00 0.00 0.00 0.00 0.00 0.80 0.00 0,00 $0.00 j6.00 a0.00 $0.00 SO.flO $0-00 36.20 $477.83 Other Deduction Notes: Training fee r-wer l Fcxx a' tffe Spi Vacation Health 8 -- pension 5 o.00 0.00 8A0 8.U0 0,00 OAO 0.00 16,00 11115MI PROJECT PROJECTS Tax Medicare Tax Halmiday Welfare GIRARDIN, FLOYD PLUAAULR 1 $225.00 S132.73 S93.10 S19.08 SO-00 $0.00 $0.00 P. O. Box 102 Fiver UNDERGROU 1 a ()-DD 0.00 2.00 2.00 la.0v o.oa a.00 4.00 $70,t)7 91,265.19 DID �5 f NO UTILITY PIPEFITTER IFringes $114174730 .,24 $1,. TrainingDues Admiral Travel& Sub Savings Other Total Dedbct, ' ❑ 0.00 0.00 0.00 0.00 0.00 0-00 0.00 0.00 $0. 00 S&.00 50.00 $0.00 50.00 50.00 ;1220 $482.11 Other Deduction Notes- Train;no foe - THIS ALL Federal FICA S State SDI Vacation Health& Pension S 0.00 0.00 5-00 6.00 8.00 8.00 0.90 32.00 $53.61 PROJECT PROJECTS Tax Medicare Tax Holday Welfare MERGIER, BRANDON I PLL*ABF_R I S367.W $184.16 $161.88 $26.48 R.00 $0-00 50-00 400 Cragmont Court f UNDERGROU 1 0.00 0.00 2.00 2.00 2.00 2.00 0.00 6.00 $70.87 51,867.90 DID Cameron Park CA Np UTILITY PIPEFf7TER 52.282.48 a2,424.22 Training Adrnin 1 Frttlges Dues Travel & Sub Savings Other Total Deduct. 0 0.00 0.00 0.00 0.00 0.00 0.00 (3.00 0.00 $0.00 $16.00 50.00 $0.00 $0.00 30-00 $16.80 $756,32 Omer Deduction Notes: Training fee THIS ALL Federal FICA $ State SDI V40BOW Health 8 Pension j S 0.00 0.00 6.00 0.00 0.00 0.00 0.00 &W $53.61 PRWECT PROJECTS Tax Medicare Tax Holiday - Welfare PASTEN ( VELASQUEZ, PLUMBER/ S89,00 $142.30 599-81 $2A.48 SM00 $0.00 $0-00 EL1SIO 1 UNDERGROU 0 O 0.00 0.00 2.00 0.00 0.0D 0.00 0.00 2.00 570.87 S1.508.64 DO 742 Bourn Dr ND UT LFTY $570.62 ;1,$73.61 Training Adrnin ! Dues Travel $ Savings Other Total 95776 PIPEFITTER Fringes Sub Oeoud. 0 0.00 0.00 0.00 0.00 GAO 0.00 0.00 0-00 $0.00 $4.00 50.00 $000 SO.00 50.00 $1340 $364.97 OtnerOeductton Notes; Training fee S = STRAIGHT -nME 'DTHER - Any other dcduebom. cantribLOwts and+or p"y Ms W"Iher nr" inducted OF raquired by prmadwrg wage dslarrn inabons must w s4p9r8 * islEd CERTIFICATION MUST he co PkWd Form it 1-131 {New 2�f1} o = OVER-nME use extra shoo") iI nr ary_ (aw reverse Sigel 0 = DOUSI-M IMP SO = STATE D1SA911-RY INSURANCE 2024 Herbert Walkup Pipeline Replacement f Herber[ Walkup Pipeline Department of CARCalifornia industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Pagel of§ (1 ) (2) 1 (3) (4) DAY SIMITIWITIFIS NET NAME,AE)DRESS AND 5CGAL 2i1 o� ° 1 WORK LTate - _ TOTAL y RATE GROSS AMOUNT DEDI1CT10N5, CONTRIBUTIONS AND PAYMENTS WAGES PAID CHECK NO. SECUP" NUMBER �� u I I� CR� a �7 I � I � I �� I �' 19� I M7 ��5 OF PAY EARNED FOR OF EMPLOYEE � W WEEK I Hours worked Each Day I THI$ ALL Federal FICA & State SDI Vacation Health & Pension S 0.00 D.00 8.00 8.00 i ODD D.DD O.00 16.00 560.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare PERE2`, SERGIO I PLUhBERI S377-oo $178,09 $153.14 $25.60 50.00 $0.00 $0.00 149 Oak Ridge Drive ( UNDERGROU 1 Q 0,00 0.00 2.09 2.00 0.0D 0.00 0.00 4,00 a60.45 S1.593.47 DID I N❑ UTILITY I PIPEFITTER $1.261.80 $2,342.70' Training Adryiin 1 Fringes Dues Travel &To1al Su4 Savings Other Deduct- ❑ &OD 0.00 ODD 0.00 D.00 000 0.00 0_00 SO-00 56.00 5000 $D.00 SO.00 $0.00 $14.80 $749,23 I 011her Oedudon Notes: Training fm -�fYia- -7S[t- cat FiUAS Stale , Vacn atio WeaLth ---_"�'- SD; S 0.00 0-0D I a.00 0.00 0.00 0.00 0.00 8.00 $53-61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare SABVL, MnRrAN I PLUMBER I --- - VMXI 4168.53 $130.641 $22.79 $D.m $0.00 $0-00 1413 Ranmo Way South Lake Tahoe I VNDERGROU 0 O 0.00 0 00 2.00 0-00 6.00 0.00 0.00 2.00 $70.87 57.461.37 DID Total 1 NO UTILITY PIPEFITTER � $570.62 $Z067.13 Tra mng 1Fring f Fringes OWS Travel & Sub Savings Other Deduct. edu I D 0-00 0.00 0.00 0-00 0.00 0-00 0.00 0.00 $0.00 $4.00 $0- 0 $0.00 SO.00 $0.00 $14.80 $625-i'8 I - Other Deduclion Notes- Trar ing fee THIS ALL Federal FICA B 8t4te SDI Vacation Health& Pension S 0.00 0.00 6-00 0.00 0.00 0.00 0.00 $.00 S9434 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare TAYLOR. KFUSTOPHER j Operating S351.DO $225.D0 S213.45 $32.35 $0.00 $0.00 SO-00 19730 Forest View En Ineer I 9 1 (Heavy $ O 0-00 0.00 0.00 0.00 0.00 000 0.00 OOO 5125. I 52,119.56 DID Crrcle Pioneer CA I Hichway work) I $567.84 $2.963.02 Training Adndn I Dues Travel & Sub Savings Other Tolai oeduct. Group 3 Area 1 FrwgeS I 1 0 0.00 0.00 0.00 0.00 0_00 0.00 0.00 ow $0.00 $7.26 $0.00 $0-DO 50.00 54.00 $2166 $843,46 Other Deduction Notes: Tralni I THIS ALL Federal FICA 8 State SDI Vec05on Health & Pension S 0.00 0.00 2.00 8.00 0-00 000 0.00 10.00 S60.00 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare TAY LOR. KRISTOPHER I PLUMBERI $351-00 $225-00 $213.45 $32.35 SO.00 $0.00 SO-00 19730 Forest View UNDERGROU 1 O 0-00 0.00 Z.C4 2.00 0.00 D.OD 0.00 4.00 $80 45 $2.119.56 DID Circle Pioneer CA 1 NO UTILITY $92i.80 $2 963A2 Training Admin ( Dues Travel & Ssvirgs Other Tptel Deduct_ 95 I PIPEFITTER Fringes Sub 1) 0.00 0-00 0.00 0-DO 0.00 0.00 0.00 0.00 $0-00 $5.60 SO 00 $0.00 $0.00 50.D0 $21.66 $843.46 OlherDeductorl Notes: Training S = STRAIGHT TWE -OTHER -Any dtWdednocris. contributions ardvw payments wheftt Of rtat rckoed or repwretl by arowaing wage debermnatms nruit be separately lisle& CERTIFICATION M= be OW01eW 0 � WERTI ME USe extra Shear(SI if nCce_csary. {Sea ntA�tm aide} Fu m P-1-131 jNew 2-40) D = D6UBLETIME SEA = STATE NSA811XrY IN*URANCE Callfamb Department of 2024 Herbert Walkup Pipeline Raplacemerlt 1 Herbert Walkup Pipeline Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 4 of 5 (1) (2) 1 (3) (4yDAY {5) '.9) (7) (8) [9) � S I M T f W l T F S I NAME. ADDRESS 2 i I WORK -I- Date NET AND SOCIAL SECURIT) NUMBER o° CLASS— S IFICATION Vol' 9102 j W03 19104 19105 I $106 9A77 TOTAL HOURS RATE OF PAY WAGES GROSSAMOUNT CHECK EARNED DEDUCTIONS. CONTRIBUTIONS AND PAYMENTS PAID NO OF EMPLOYEE � � 1 I Hours Worked Each Day WFOR EEK I S 0.00 0.00 &00 8,D0 8DO 0.00 O.OD 24.00 S99.64 THIS ALL Federal FICA& State 5D1 PROJECT PROJECTS Tax Medicare Tax Vacation Health& Pension Holiday Welfare YOUNG JIM Operating P. 0. Box 58 Engineer 5132.7 SSw-00 $29129 $306.12 $41.88 SO.GO $0.00 $0,00 95629 1 (Heavy & 0 lHighway work) I 0.00 0.00 2.00 2DO 2.00 0.00 O.Op B,pO 1 Adrrdn I Travel 9 52.37$.25' D!D Group 3 Area 1 — $3,187.62 $3.851.82 Training Dues Total Saongs Other Frtrmqe5 Sub DeducL D 6.00 0.00 0.00 0.00 0,00 Om 000 ' 0.00 $0.00 S36.30 MOD $0.00 50.nn $0.00 $775.28 SlAT15 7 OlhQr Deduction Notes: Trainine feP Cal SnrwAM S = STRAIGHT TIME 'OTHER — Any other ded diam conlrbubom mn6CX payments whether or nal indudcd or rmirred by prevailing wage deScrminatam must be seperaWs listed.-CE"FICATION AAUS b> mmpkhcd Form A-1-131 [New 2—M p . [7MBLETIM TIME Use exta sheel(%) tf necossary. tSCC rCvrCrSe SidCj E SDI = STATE DISABgJTY INSURANCE C dustri a Department of tn[fustr-ia! Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE �CONTRACTORISUBCONTRACTOR fVinciguerra Construction, Inc. FIRST DAY AND DATE OF PAY PERIOD 91112024 2024 Herbert VNe€kup Pipeline Replacement! Herbert Walkup Pipeline PUBLIC WORKS PAYROLL REPORTING FORM Page 5of_5 CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERIOD 917l2024 I do hereby certify under penalty of perjury: (1) That I pay or supervise payment to empk:yees of the above -referenced contractor on the above -referenced contract. All persons employed on said projectforthe above --referenced tirne 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 weettly wages earned by any person and that no deductions have been made either directly or irufirectly 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 Tequired to be submitted for the above period are correct and cornptete; 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 taborer 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. (b) That fringes benefits as listed in the contract (a) El 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 employees), except as noted Wow. (c) 0 See exceptions noted below. EXCEPTION CRAFT EXPLANATION REMARKS: Except for Training funds for at€ crafts paid directly to CAC. NAME PLEASE PRINT.) TITLE p // l r T aF�d d'i AV 5 7?-t V r ii G�� iJ@�?'Z`. SIGNATURE. f DATE I 101912024 On federally -funded projects, perrnisslble 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 falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (See section 1001 of title 16 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 (916) 6r.,-4-f410 or TDD (916) 654-3880 or write Records and Forms CEu 260 Management, 1120 N Street, MS-89, Sacramento, CA 95814. Certified Payroll Report for Non -Performing Week Contractor: Vinciguerra Construction, Inc. For week beginning on: 9/6/2024 For week ending on: 911412024 Payroll Number: 23 Project: Herbert Walkup Pipeline 2024 Herbert Walkup Pipeline Replacemen In Res. area between Herbert Ave. and We up Rd. South Lake Tahoe CA 96150 CERTIFICATION FOR NON.PERFORMIN4 WEEK I, Chris Molinelli the undersigned, am the Bi Construction, Inc certify under penalty of perjury that no work 1 herein certify under penalty of isomm7dommi with the authority to act for and on behalf of Vinciguerra is performed for the week ending on: 9/1412024. of the above is true and correct as submitted. 10/10/2024 California jM% Depar1nlent of 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline indusUlaiReiations PUBLIC WORKS PAYROLL REPORTING FORM P I NAME OF CONTRACTOR: Vinciguerra Construction, Inc. CONTRACTOR'S LICENSE NO.: 3581338 ADDRESS: P. O. Box 157, Sutter Creek, CA, 95695 JOR SUBCONTRACTOR: SPECIALTY LICENSE NO.: I PAYROLL NO. I FOR WEEK ENDING f SELF-�N$URED CERT: PROJECT OR CONTRACT NO.: Ha►t�art Walkup Pipeline 1 24 9121/2024 IWORKERS' COMP: PROJECTAND LOCATION: 2024 Herbert Walkup Pipeline Replacement, ELD �1) (2) l (3) (4) DAY (5) (6) (7) (8) (9) SIMITIWITIF15 NAME, ADDRESS j P � WORKCLASS -- Dale NET AND SOCIAL SECURITY NUMBER 062 a d% IFICATION 9f15 9I1fi 91}7 t311B 9119 9120 I I I I 9121 TOTAL "OUR5 HOURL 4Fpnv GROSS AMOUNT EARNED DEDUCTIONS WAGES WAGES PAID CHECK NO- OF EMPLOYEE 'T. l FOR I Worked Each Day WEEKFlgtxr S 0.00 O,pU 0.00 0-00 SAO 7.00 0.00 15.00 553.61 THIS ALL Federal PROJECT ALL Tax FICA & Slate SLIT Medicare Tax Vacation Health& Pension Holiday Welfare GIRARDIN, FLOYD P.4. Box 102 River f PLUMBERI ) UNDERGROU S62-DC $63.75 516 44 S9.17 50.00 $0.00 $0,00 5 } l NO UTILITY O 0.00 0_00 ODD 0-00 0.50 0,00 0.00 0.50 S70.87 $B82 D10 PIPEFITTER 3639.59 $839.59 Training Adrrd,) 1 Dues Travel B Savings Other Total Fringes Sub DeducL D 9.DD 0-00 0.00 0.00 0.00 0.00 0.00 0.00 $O.DO • $6-20 50.00 54.00 $0.00 50.00 $6.20 $157.56 Other Deduction Worse: Tag Fee ! S 0.00 8.00 6-00 0,00 8.00 8-00 0.00 30.DO S53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA & State Medicare Tax SDI Vacation Health & Holiday Welfa a Pension GRIEGO, DAVID 1730 Rock Springs PLUML3ER I UN LRAB ft 1 S249.00 $140,98 S I D7.18 320.27 50.00 $[I DD 50.00 Rued Esogrt do CA 0 NO UTILITY O 0.00 1-00 0.00 0.00 2.00 0.50 0.00 3.60 S70.87 $1 325.52 DID PIPEFIITER $1.85f3.35 $1,$56.35 Training Admin I Travel 8 Dues Sub TotalFringes Savings Other Dedud. D 0.00 0.00 0.00 0.00 O.Ov O.Oii 0.00 0.00 $0.00 S13.40 SO-00 $0.30 SO.A0 $100 $1340 $530,83 Other Deduction Notes: Tq in ing ! 8 00 .00 0.00 .00 0.00 8.00 0.00 0.00 43.00 S53.61 THIS ALL Federal PROJECT PROJECTS Tax FICA & State SDI Medicare Tax Vacation Health 8 Pension Holiday Welfare MERRCIER. I - 400 NDONCregmw 400 Court PLUMBERI UNDERGROU $0.00 $215.30 $0.00 $30,95 $0-00 50.00 $0.00 Cameron arkont C�2ron Park CA 1 O 0.00 0,00 0.00 0.00 2.00 0.00 0.00 2.00 $70.87 $2.FS8-14 DID PI FITTER � $570.62 52,83d.00 Training Admin I Travel 8 �� Savings Omer Total Fringes Sub Deduct a.aD a.00 tt.oD o.ofl a.Da n.oD a -Do o.DD So .Do - ii � $4.00 50.00 $0.00 50.00 $t3-D0 $19.60 $265.88 Other Deduction Notes. Training fee SS = SiRAIG TIME -OTHER -Any outer dad-wtons. conlmutionc arrryor payments whether or net nducred or regrnrod by pwmiing wage dcrerrniret&m must be seprarsP* baled. CERTIFICATION (JUST he a mple4W Form A-1--131 (Near 2-M) 0 s OOUBLEIE Use extra shcer &) if necessary. ;See reverse sde) Sot = STATE 04SABILITY INSURANCE CDepartmat�fomea 2024 Herbert Walkup Pipeline Replacement 1 Herbert Walkup Pipeline ent of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page,? of (1) (2) I! (3) (4) DAY [5} L6f [kT r SIMITIWITIFIS NET NAME, ADDRESS AND SOCIAL 291 ou0 WORK J CLASS- Date TOTALY RATE HOURL GROSS AMOUNT DEDUCTIONS. CONTRIBUTIONS AND PAYMENTS WAGES PAID CHECK MO. SECiJRIIY NUMBER ; i J IFICATION 9115 l 9fi6 19117 I Sf18 19I79 191?p 19R1 HOURS OF PAY EARNED FOR OF EMPLOYEE 3 G WEEKHours i Worked Each Day THIS ALL Federal FICA & State SDI Vacation Neattfl & Pens S 0,00 0.00 0.00 0.00 8.00 7.50 0.00 15.50 S53.61 PROJECT PROJECTS Tax Medreare Tax Holiday Welfare PASTEN VELASOUEZ, I PLUMBER/ $0.00 $55.79 311.69 S9.46 $0,00 S0.00 50-M ELISIO 0 l UNDERGROU O 4,00 0.00 0,00 000 0.5t) Q 00 0.00 0.50 $70.87 $773.06 DID 742 Bourn Or Wpod�95775 l NO UTILITY PIPEFITTER $356.40 $866-40 Training Admin! Fringes Dues have!$ Sub Savings Other To[31 Deduct J D 0.00 0,00 0.00 0.00 0.00 0.00 000 0.00 $0.00 $6.40 $0.00 $O.OD $0,00 S0.01D $0.40 $93.34 J - - Other Deduction Notes: 1 r rna FALL reGwui viLA $'late SDI Vacation Heahh & � -J Pension l a^ 0.00 8.00 8.00 0.00 8,00 7.00 0.00 31.00 $60.00 PROJECT PROJECTS Tax Madirare Tax Holiday Weffa a PEREZ.SERGIO I PLUMBER/ $368.00 $175.03 $149.65 $25.17 50.u0 $0.00 $0.00 149 Oak Ridge Drive 1 UNDERGROII O 0 1.00 2.00 0.00 2.00 0.00 D.00 5-00 580.45 _ - S1.570.03 DID tone CA 96640 - J ND UTILITY PIPEFITTER $2,262.25 $2,302.4$ Training Arinat Fringeses Dues Travel & Sub Savings Ocher Total Deduct. 1 fJ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50.00 $14.40 $0.00 $0.00 S0.00 S0.00 $1460 $732.45 J r Other Dedud[on Notes Traintngfea THIS ALL Federal FICA & State Sal Vacation Vacation Heath & Pension J S 0,00 0.00 0,00 0-00 8-00 7.50 0.00 15.50 $53.61 PROJECT PROJECTS Tax Me6cam Tax Welfare SABW MORGAN J PLUMSER I 565-00 $65.79 S20.82 59.46 $0.00 $0.00 SO-00 1413 Rancho Way Scum Lake Tahoe U J UNDERGROU O 0.00 0.00 0.00 4.00 0.50 0.00 0.00 0.50 $70.87 i898.93 0!6 J NO UTILITY J PIPEFITTER S813t3.40 $966.40 Training F" fi Dues Travel Sub Savings Other pedauf. D 0.00 0,00 OAO 0.00 0,00 0,00 U_00 0.00 SO-00 $6.40 50,00 $0.00 50.00 S0.00 $6.40 $167-47 Other Deduction Notes; Trarnino Fee - THIS ALL Federal FICA & Stale SDI Vacation meaRh & Pension l S 0.00 &00 8.00 8-00 8.00 8.00 0.00 40.00 $99 64 PROJECT PROJECTS Tax Medicare Tax Holiday Welfare VINCIGUERRA. AUSTIN J Operating 5783,00 a371.62 $443,49 $53.44 $0.00 $0.00 SO.DO 330 Bodega Cam FJ 2 E rnaer J � e vy & ❑ 0-00 2.00 2.00 0.00 2A0 V.00 0. OD 8.00 513?.7 1 $3.244.75 DID Dorado HMIs CA JH' hwa work J t9 y } §+f,781.86 $4.914.57 Training Ildmin ! Fringes Dues Trav2i & Sub Savings Other Tooted Deduct MiloJ J Group 3 Area 1 J D 0.00 0.00 0.00 0.00 4.00 0.00 0.00 0.00 $0.00 $s&5_66 $0_00 ;0,04 SO-00 S0.00 $58,$7 $1A74A 2 Other Deduction Notes; Training fee S - STRAIGHT TIV r: -OTHER-Any olhm deduc4ons. omL :t tom anWor payrncr+ts whotl er or rat included or mquirW by Prevaring waW ftlerr11inatipns must be SeParalety listed GER17MATION WST be oxnpi ited 0 = OVERTIPE Use extra sho"s) it neoassary. (See m%-wm side) Form A-1-131 {New 2-0} 0 r DOUBLETIME SEA = STATE OISABIt1rY WSURRNCE California 2024 Herbert Walkup Pipeline Replacement f Herbert Walkup PiWine t7epartrnent of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM Page 3 of (1j (2) I (3) (4) DAY i51 ;61 f+; {$j (9) I I S I r.1 I T I W i T F 5 NET NAME. ADDRESS ANOS13ClAL ai qac WORFL Date TOTAL HOURL r RATE GRASS AMOUNT DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS WAGES CHECK PAID SECURITY NUMBER 6-1 CLASS- = I 9115 19fla 19117 j 9f1,S 9119 j 9120 19121 rouRs OF PAY EARNED NO. FOR OF EMPLOYEE w IFICATION 3 WEEK l I-Im-s WoffKed Each Day THIS ALL Federal FICA A State SDI Vacation Health & Pension 5 0-00 0 04 8.00 O.M 8-00 7.00 0.00 23-00 $53-61 PROJECT PROJECTS Tax Medicare Tax Holiday Welfara WILLSON. SLOAN I PLUMSERf 5164-00 $117,88 S67.14 $W-96 SO.00 $O.Go $0.00 3020 NCWton Road, Sp. 1 PlacerAle CA I UNIDERGROU 5 O 0.00 0-00 2.00 0.00 2.00 0.00 0-00 4-00 $70.87 Si 059.59 FWD + NO UTILITY PFPEFITTER I $1.516,51 $1,551.95 Training Flanges Oues r Sub vel Total Savings Diner p ducL I 0 0.00 0.00 0.00 0-00 0.00 0.00 0.00 0.00 $0.00 S10.80 S0.00 $0.00 $0.00 $0-00 S125.38 $492.36 C wr OeducWn Notes- Training Fee. Garnishment Two -7St�t- -F i _ -I-IuKek -Sim SDI Vacation Heal►Fr -- Ptim1O" - - - I S 0.00 0Ao 0.00 0.00 O.00 0.00 0.00 &00 M64 PROJECT PROJECTS Tax Medicare Tax Welfa HoWelfare YOUNG. JIM I Operating - $73$.00 $350.80 $384.71 l;50.44 SO-04 ffi0.00 $0.00 P. Q- Box 58 En meet 1 I [Hoary 8 (He O D-00 0.00 0.00 D_00 2.i�o 0.00 D-00 2.0D $132.7 1 $2.765.71 IVD Fkkk--tovm GA 96629 - IH- waJ1c 1 t9 Y f $1,062.54 $4.599.55 Training Admin I Fringes Travel S Dues Sub Total Sawlgs Deduct- I Group 3 Area 1 I D 100 OX 0.00, 0.00 0.00 0-00 0.00 O.OD $0.00 S12.10 $0-00 $0-00 $0.00 SO-00 $289,89 51 &134& - Other Deduction Notes. T raino+g lee. Cal Savers S = sTRAIGHT TIME -OTHER -Any otr,ex deducwns. cvrrlrttuGQrQ anWor payments wheftror not iodixied or required by prevailing wage determMij= mwA ba separalelp listed. CERTIFICATION MU be aontpleted 0 = OVERT] ME US,' extra Wlieeusj it necessary. {See n&v2 se sidel Feim A-1-131 {Mew 2-013) D = DOL&LE li& 301 = STATE DISABILITY INSURANCE California Depmtraertt of Industriall Relations STATE OF CALIFORNIA STATEMENT OF COMPLIANCE CONTRACTOR) SUBCONTRACTOR Vinciguerra Construction, Inc. FIRST DAY AND DATE OF PAY PERICD 911512024 do hereby certify under penalty of pedury: 2024 Herbert Walkup Pipeline Replacement f Herbert Walkup Pipeline PUBLIC WORKS P"ROLL REPORTING FORM Page 4of4 CONTRACT NUMBER Herbert Walkup Pipeline LAST DAY AND DATE OF PAY PERiOD 91211202,4 (1) That I pay or supervise payment to employees of the above —referenced contractor on the above-4eferenced contract. Atl persons employed on said project for ]he above-4eferenoed Gme period have been paid their futl weekly wages earned: that no rebates have been or will be made either direelly 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 earrmd by any person other than permissible deductions. (2) That this employer has complied with the requirements of the California Labor Code Section& 1771, 1811, and 11815 for all pefforrrred on this public works project, and that the classifications set forth therein for each trade rate conform with the worst 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: (aJ [3`80e6a rn Opp icable wage determination incorporated into the contract; (b) 0 Delermined 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 worst 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) El 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) IJ Have been paid directly to the listed employee(s), except as noted below, (c) M See exceptions noted below. EXCEPTION CRAFT REMARKS: Except for Training funds for all crafts paid directly to CAC. EXPLANATION NAME (PLEASE PRINT.) TITLE A us -on SIGNATURE: DATE 1 1011012024 �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, (4O U. S. C. 276c). Also, the willful falslfcatron of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (See section IDOI of We 18 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 (916) 654-6410 or TDD (916) 654-3880 or write Records and FcTrns CEM 25W Management, 1120 N Street, MS-89, Seerarnento, CA9a814.