The URL can be used to link to this page

Home My WebLink About06 Name(s) and Address(es) of all Subcontractor(s) performing work on this projectCity of San Luis Obispo Bid 1000023 BID FORMS LIST OF SUBCONTRACTORS Pursuant to Section 4100 of the Public Contracts Code and section 2-1.33C of the standard specifications, the Bidder is required to furnish the following information for each Subcontractor performing more than 1/2 percent (0.5%) of the total base bid. Do not list alternative subcontractors for the same work. Subcontracting must not total more than fifty percent (50%) of the submitted bid except as allowed in section 5-1.13 of the standard specifications. For Streets & Highways projects, subcontractors performing less than ten thousand dollars ($10,000) worth of work need not be mentioned. Subcontractors required to pay prevailing wage, must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5 to be listed. NOTE: If there are no subcontractors, write "NONE" and submit with bid. Name Under Which Subcontractor is Licensed S,F,e License Number Attach additional sheets as needed. DIR Public Works Address and Phone Specific Registration Number of Office, Mill or Description of Number Shop Subcontract I (OVOM 7ri 1(4 L k-1. ST ST&.Izr BID FORMS 8 SAw n l,,.a_ CA 53 q,( cd"S. 52-f- 'a7Jr hb'S ( T)-IL17 J) Tfi�-aFF'rc � .1*i� % of Total Base Bid Z.II 4/12/2019 4:56 PM p. 29 CalPortland Company 2025 E Financial Way Glendora, CA 91741 C;) CAL?ORTLAND' STATEMENT OF COMPLIANCE Contract Number (9.967) FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD 7/15/2019 7/21/2019 I do hereby certify under penalty of perjury: (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 eamed by any person other than permissible deductions, and described below: (2) 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) FiSpecified in the applicable wage determination incorporated into the contract; (b) DX 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. For Ready Mix Delivery county is based on location of the Batch Plant. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency. Note: Ready Mix Drivers are not an apprenticed craft. (4) That fringe benefits as listed in the contract: (a) nX Have been or will be paid to the approved plan(s), fund(s), or program(s) for the benefit of listed employee(s), except as noted below. (b) FiHave been paid directly to the listed employee(s), except as noted below. (c) X❑See exceptions noted below. EXCEPTION CRAFT EXPLANATION Driver Mixer Truck See Fringe Benefit Statements REMARKS: 404873 Guzman, Rafel other ded- 401K $121.71, Delta Dntl $ 9.33 Vision $4.40 Anthem EPO $162.16 405127 Alexander,Tyson other ded- Delta Dntl $9.33, 4011 $ 66.44 NAME (PLEASE PRINT.) TITLE Vicky Acost Payroll Analyst - Prevailing Wage SIGNATURE DATE 10/7/2019 US Department of Labor PAYROLL �� Employment Standard Administration (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347!nstr.htm) Wage and Hour Division porc„nc �.o .,.,� .o.,,,i�e.I r„ oo,.,,,..a F,. a,. _,.n,...,:,.....0 :..�_�._�:__ .._�___ •� I:__._-_ ... __ __ "AI ?ORTLAND - - ---- -- - --- -�-- -- -- '-_,'_.._ _.. �... ...... NAME OF CONTRACTOR ❑ OR SUBCONTRACTOR ❑ CalPortland Construction ............. .•.•..•.. ....1-1..... .1 a -1-1-r vaitu v11D WIMUI IIUIIIUCI ADDRESS 2025 E Financial Way, Glendora, CA 91741 PAYROLL NO: 1 FOR WEEK ENDING: 7/21/2019 PROJECT AND LOCATION: Papich Construction Company South Broad St. Improvements Batched out of: various locations PROJECT OR CONTRACT NO: C/4- h0o0Z� (19.967 " NAME, PLANT HOME ADDRESS, AND LAST 4 DIGITS OF SOCIAL SECURITY NUMBER OF EMPLOYEE 9 6 o z 3 WORK CLASSIFICATION S T �r O T TOTAL HOURS RATE OF PAY / CASH FRINGES GROSS AMOUNT EARNED PROJECT / ALL DEDUCTIONS NET WAGES PAID FOR WEEK CHECK NUMBER Mo Tu We Th Fr Sa Su 15 16 17 18 19 20 21 MEDICARE SOC SEC FEDERAL W/H TAX STATE W/H TAX SDI OTHER TOTAL DEDUCTIONS Guzman, Rafel 1389 20t1� St Oceano CA 93445 -8965 S-1 Driver Mixer Truck S 1.52 L52 $2547 . $92.97 $39.56 $169.17 $327.61 $116.63 $27.24 $297.60 $977.81 $1,922.44 DIRECT DEPOSIT 00404973000 51001 O 1.42 1.42 $38.21 $2,900.25 Alexander, Tyson 263 Spntce St #D Arroyo Grande CA 93420 -0074 M-5 Driver Mixer Trucic S 0.00 $25.47 $92.37 $45.78 $195.75 $190.73 $49.17 $31.55 $75.77 $588.75 $2,575.03 DIRECT DEPOSIT 00405127000 23001 $1. O 2.35 2.35 $3g.21 1 $3,163.78 $1.10 Driver Mixer Truck S 0.00 $0.00 $0.00 $0.00 O 0.00 Driver Mixer Truck S 0.00 $0.00 $0.00 $0.00 O 0.00 Driver Mixer Truck S 0.00 $0.00 $0.00 $0.00 O 0.00 Driver Mixer Truck S 0.00 $0.00 $0.00 $0.00 O 0.00 While comoletion of form WH-3d7 i<nntlnnal Driver Mixer Truck S 0.00 $0.00 $0.00 $0.00 O ....------ _.. --.:_____., 0.00 - - ---- ------ ---------------- -.-- -- ••e •--• •• -•• • �•--•-••. ••......P11- Ll t,r contained in Ly t..r.n. 99 s.S,:.5(al, ine Lopelan l Act (4U U.5.C, § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paideach employee during the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construcion project, accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less then the proper Davis -Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that it will take an average of 55 minutes to complete this collection, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspectof this collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room 53502, 200 Constitution Avenue, N.W. Washingtion, D.C. 20210