HomeMy WebLinkAboutRedacted - WATERLINE 91436 WEEK 2 ENDED 09.29.18( 1 )
NAME, ADDRESS AND
SOCIAL SECURITY NUMBER
OF EMPLOYEE
Elliott Woeste
772 Crystal Way
Nipomo, CA 93444
Jacob D Rexford
2761 Chaparral Lane
Paso Robles, CA 93446
Jacob D Rexford
2761 Chaparral Lane
Paso Robles, CA 93446
James Douglas
612 Laura Way
Paso Robles, CA 93446
James Yanez
538 County Lane
San Luis Obispo, CA 93401
xxx-xx-xxx
Jose Sanchez Garcia
558 Ferro Lane
Paso Robles, CA 93446
Juan Manuel Barrios
1021 Gaylene Dr
Santa Maria, CA 93458
xxxx-xx-xx
Manuel Robledo
9694 Birmingham Ave
Riverside, CA 92509
Timothy D Ambrosi
1199 W Hwy 246 #C
Buellton, CA 93427
FORM A-1-131 (New 2-80)
( 2)
Number of
diR Callfomla Departme,,t
of Inaustrla! Relations PUBLIC WORKS PAYROLL REPORTING FORM
NAME OF CONTRACTOR 0-KAL Engineering CONTRACTOR'S LICENSE # 653307 ADDRESS OR SUBCONTRACTOR SPECIALTY LICENSE # PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE# PROJECT OR CONTRACT # 2 9/29/2018 WORKERS' COMPENSATION POLICY # 7J45679A 17 PROJECT & LOCATION 41 DAY ( 5) ( 6) ( 7) ( 8) ( 3) Sun Mon Tue Wed Thu I Fri Sat GROSS AMOUNT DATE HOURLY EARNE D
PAGE
PO Box 1919 San Luis Ob isnn CA 93406
Waterline Replace Spec 91436
San Luis Obisoo
( 9)
NET
WAGES Wrthholdlng WORK 9123 I 9/24 I 9125 9126 9127 9/28 I 9/29 TOTAL RATE THIS ALL DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID FOR
Exemotlons CLASSIFICATION HOURS WORKED EACH DAY
0 Laborer
0 Equ ip. Opers.
0 Laborer
0 Laborer
0 Equip. Opers.
0 Laborer
0 Laborer
0 Laborer
0 Equip. Opers.
s 0 0
D
0 0 0
s 0 0
D
0 0 0
s 0 0
D
0 0 0
s 0 8
D
0 0 1
s 0 8
D
0 0 1.5
s 0 8
D
0 0 1.5
s 0 8
D
0 0 1.5
s 0 8
D
0 0 0
s 0 8
D
0 0 0
s
D
0
s
D
0
s
D
0
S = Straight time o = Overtime
D = Do ubletime
0
0
0
0
0
0
8
0
8
0
0
0
7
0
8
0
6
0
HOURS OF PAY PROJECT PROJECTS WEEK
FWH MCARE FICA ST TAX SDI VAUHOL HEALTH/WELF PENSION
0 0 4 0 4 $ 55.73 $ 460.00 t 50.20 $ 214.63 $ 232.82 $ -$$ -$ $ 769.30 $ 3,461.84 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $ 2,306.69
0 0 7.5 0 7.5 $ 72.85 $ -$ $ $ $ -t 197.50 $ 1 155.15 002853
FWH MCA RE FICA ST TAX SDI VAC/HOL HEALTH/WELF PENSION
0 8 3 0 11 $75.23 $ 681.00 $ 54.04 $ 231.06 $ 322.09 $ $ $ -$$ 925.41 $ 3,726.87 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $ 2,143.82
0 1 0 0 1 $97.88 $ $ $ $ $ $ 294.86 $ 1 583.05 002856
FWH MCARE FICA ST TAX sDr VAOHOL HEAL TH/WELF PENSION
0.5 0 5 0 5.5 $ 55.73 $ 681.00 $ 54.04 $ 231.06 $ 322.09 $ $ $ -$ -
$ 1,334.91 $ 3,726.87 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $ 2,143.82
0 0 8 0 8 $ 87.57 $ $ -$ $ $ $ 294.86 $ 1 583.05 002856
FWH MCARE FICA ST TAX SDI VAC/HOL HEAL TH/WELF PENSION
8 8 8 0 40 s 58.38 $ 478.00 $ 50.12 $ 214.32 $ 237.74 $ -$ -$ -$ -
$ 3,456.78 $ 3,456.78 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $ 2,204.10 3.5 2 8 0 14.5 $ 77.35 $ $ $ $ $ $ 272.50 $ 1 252.68 002857
FWH MCARE FICA ST TAX SDI VArlHOL HEALTH/WELF PENSION
8 8 8 0 40 $ 75.23 $ 995.00 $ 65.63 s 280.63 $ 415.66 $ $ -$ $ -
$ 4,526.34 $ 4,526.34 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $ 2,491.92 4 2 8 0 15.5 $97.88 $ $ -$ $ -$ $ 277.50 $ 2 034.42 002858
FWH MCARE FICA ST TAX SDI VAhHOL HEALTH/WELf PENSION
0 0 8 0 16 $ 55.73 $ 162.00 $ 35.53 $ 151.93 $ 108.70 $ $ $ -$ -
$ 1,620.18 $ 2,450.35 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $1,809.69
0 0 8.5 0 10 $ 72.85 $ -$ $ -$ $ $ 182.50 $ 640.66 1774
FWH MCARE FICA ST TAX SDI VAUHOL HEAL THIWELF PENSION
8 8 8 0 39 $ 55.73 $ 516.00 $ 47.36 $ 202.50 $ 265.28 $ $ $ $ -
$ 3,266.22 $ 3,266.22 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM $1,965.08
4 1.5 8 0 15 $ 72.85 $ $ -$ $ -$ $ 270.00 $ 1 301.14 002859
FWH MCA RE FICA ST TAX SDI VAC/HOL HEAL TH/WELF PENSION
8 8 8 0 40 $62.02 $ 344.00 $ 44.38 $ 189.77 $ 180.51 $ $ $ $ -
$ 3,218.35 $ 3,714.51 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHK NUM $ 2,057.15
3 1 5 0 9 $ 81.95 $ -$ -$ $ -$ -$ 898.70 $ 1 657.36 1775
FWH MCARE FICA ST TAX SDI VAC/HOL HEAL TH /WELF PENSION
8 8 8 0 38 $75.23 $ 791.00 $ 56.35 $ 240.96 $ $ $ $ -$
$ 3,886.48 $ 3,886.48 TRAINING FUNOADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHK NUM $ 2,555.67
3 1 6.5 0 10.5 $97.88 $ -$ $ $ $ s 242.50 $ 1 330.81 1776
FWH MCARE FICA ST TAX SDr VAC/HOL HEALTH/WEI.F PENSION
TRAINING FUNOADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHK NUM
FWH MCA RE FICA ST TAX SDI VArlHOL HEAL TH/WELF PENSION
TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SDI VAC/HOL HEAL THIWELF PENSION
TRAINING FUNOADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
* OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing
wage determinations must be separately listed. Use extra sheet if necessary. CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com
EEHEgs$g$E$f,?EgFHFEF+FsF'a is$i=*i'+ FHFEF
EFE$gFi$FFiiifrFEFFF
EEe$eaig+FEEEEEHEEi;e4g +=3q?s;+e " l*lslelr
FgFE3$sii;;faHt+ffiH
E eEa6' s 18."o
=NJ
UI{
-{m
=mz{o1too3!
ti
zom
I.lmF-{t{.ll
l-lfl
ozczIm,
!nrz
F{
o
!rtl
d
F
m3
cr or*-X € E€
I cea-rvEe:qondFx 0nB<r 'm: =i P-Lr<mv ,r!l_= -!.-rY
=l6 z= J=;E€6d9-tnciaq1il16ftldei 6
BFTH;+ H} g1d $ Ho;
= 5I =8: = =q z.
=E ip q qPt€ =; q
90= ldx o T-o Y oo i ti3 A +-* I uii€ Q A5 ui
==lD 9l I >X =.6 f (D >5=:el4frdF+ds H
dBFfi: Elii++ E
-gqaD=-;\'=co = I6;6-o-!x =h o.i fr'9ai -lgf,gle re{=';i ;g 6 =- 9A9 +:,8 -e::*I .i*.,e6i$9 A!!.)l x tu v:^H;1 :id=:oJ F'YOo=tTl*'<.i X |t-X -a^ ii g
=€-=X gHa[; !
=3 E _j - 5r-f JH. F:3;5 ode; =X ^i :r -{ n< ^i u5 F d q P o =a3;=fr 48-4 i-'--4)i -iD{rG r - = Usss:-;
=od =o6
m
.)maf
z
o
J
o
r
9r
c
a
=.3
>Ito
3F
o
o
OJ
'Eq
c
g.
o_
r
mX-9tz.4
6z,
s8r-.t1nt;€E>=
=oxHpg
uF:
192
Foo
3=l
6P<r)=>o!-<R2?9V!4>F
=HFl9-.r
2>>5