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Public Works Certified Payroll Reporting Form
Certification under penalty of perjury:
"I, ALLISON MICKELSON, the undersigned, am the OFFICE MANAGER (position in business) with the authority to act for and on behalf of AQUA CONSTRUCTION.INC. (name of business and/or contractor), certify under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2019-08-23 are the originals or true, full, and correct copies of the originals which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2019-09-25."
Contractor Name: AQUA CONSTRUCTION INC. Contractor PWCR: 1000002113 License Type: CSLB License Number 992227
Address: 449 W. FOOTHILL# 272, GLENDORA, CA 91741 FEIN: 464958809 Contractor Email: NUGGMAN@AOLCOM
Insurance Number: CST5015647
Awarding Body: CITY OF SAN LUIS OBISPO DIR Project ID: 298806 Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Contract With: CITY OF SAN LUIS OBISPO County: SAN LUIS OBISPO Address: 900 SOUTHWOOD, SAN LUIS OBISPO, CA 93401
Payroll#: 1 - 0 Ctr Payroll#: 1 Week Ending: 08/23/2019 O Statement of Non-Performance? D Final payroll for this project?
Employee: MIGUEL CRUZ VELASQUEZ 571 RICHLAND ST. UNIT L, UPLAND, CA, 91786
SSN: 925951916 Sat Sun Mon Tue Wed Thu Fri Total Total Vaci Health Total
Hours Base Hourly Fringe Holiday &Welf. Pension Other Training Hourly Rate 08/17 08/18 08/19 08/20 08/21 08/22 08/23
S PLASTER TENDER 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 60.30 0.00 0.00 0.00 0.00 0.00 0.00 60.30
NOTE: CHECK 12963 Travel & Subsistence 0.00 Total Deductions 142.22
Public works certified Payroll Reporting Form 09/25/2019 -Page 1
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER Week Ending: 08/23/2019 Payroll Number: 1-0 I
Employee: JORGE VALLARDARES 1642 ARROYO, POMONA, CA, 91768
SSN: 3709 Sat Sun Mon Tue Wed Thu Fri Total Total Vaci Health Total Hours Base Hourly Fringe Holiday &Welf. Pension Other Training Hourly Rate 08/17 08/18 08/19 08120 08/21 08/22 08/23
s PLASTER TENDER 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 60.30 0.00 0.00 0.00 0.00 0.00 0.00 60.30
NOTE: CHECK # 12959 Travel & Subsistence 0.00 Total Deductions 118.61
Public works certified Payroll Reporting Form 09/25/2019 -Page 2
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Employee: RICHARD G SMITH 947 1/2 COLTON AVE., COLTON, CA, 92324
SSN: 2571
S PLASTER TENDER
NOTE: CHECK# 12956
Sat
08/17
0.00
Sun
08/18
0.00
Mon Tue
08/19 08/20
8.00 8.00
Wed
08/21
0.00
Thu
08/22
0.00
(
Fri
08/23
0.00
Total
Hours
16.00
Base Hourly
60.30
Total
Fringe
0.00
Week Ending: 08/23/2019
Vaci
Holiday
0.00
Health
&Weir.
0.00
Traver & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total
Hourly Rate
60.30
214.50
Public works certified Payroll Reporting Form 09/25/2019 -Page 3
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Employee: RAMOS E. FREDY 1464 S.PALOMARES ST. 30, POMONA, CA, 91766
SSN: 4987
S PLASTER TENDER
NOTE: CHECK# 12951
Sat
08/17
0.00
Sun
08/18
0.00
Mon
08/19
8.00
Tue
08120
8.00
Wed
08121
0.00
Thu
08122
0.00
(
Fri
08123
0.00
Total
Hours
16.00
Base Hourly
60.30
Total
Fringe
0.00
Week Ending: 08/23/2019
Vaci Holiday
0.00
Health
&Welf.
0.00
Travel & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total
Hourly Rate
60.30
118.62
Public works certified Payroll Reporting Form 09/25/2019 -Page 4
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Public Works Certified Payroll Reporting Form
j Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Employee: MARCI AL CONTRERAS 594 E. ?TH ST. APT D, UPLAND, CA, 91786
SSN: 2893
5 PLASTER TENDER
NOTE: CHECK# 12936
Sat
08117
0.00
Sun
08/18
0.00
Mon Tue
08119 08/20
8.00 8.00
Wed
08/21
0.00
Thu
08/22
0.00
(
Fri
08/23
0.00
Total Hours
16.00
Base Hourly
60.30
Total Fringe
0.00
Week Ending: 08/23/2019
Vaci Holiday
0.00
Health &Welt
0.00
Travel & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total Hourly Rate
60.30
11863
Public works certified Payroll Reporting Form 09/25/2019 -Page 5
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Employee: ENRIQUE CRUZ 1642 ARROYO AVE., POMONA, CA, 91768
SSN: 9750
S PLASTER TENDER
NOTE: CHECK# 12939
Sat
08/17
0.00
Sun
08118
0.00
Mon
08119
8.00
Tue
08120
8.00
Wed
08121
0.00
Thu
08122
0.00
(
Fri
08123
0.00
Total
Hours
16.00
Base Hourly
60.30
Total
Fringe
0.00
Week Ending: 08/23/2019
Vaci
Holiday
0.00
Health
&Welf.
0.00
Travel & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total Hourly Rate
60.30
118.62
Public works certified Payroll Reporting Form 09/25/2019 - Page 6
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.O. SWIM CENTER THERAPY POOL REPLASTER
Employee: CRISTIAN ZUNIGA ESCOTO 1877 E. ROSEWOOD CRT UNIT B, ONTARIO, CA, 91764
SSN: 9467
S PLASTER TENDER
NOTE: CHECK# 12942
Sat
08117
0.00
Sun
08/18
0.00
Mon Tue
08/19 08/20
8.00 8.00
Wed
08/21
8.00
Thu
08/22
8.00
(
Fri
08/23
8.00
Total
Hours
40.00
Base Hourly
60.30
Total
Fringe
0.00
Week Ending: 08/23/2019
Vaci
Holiday
0.00
Health
&Welf.
0.00
Travel & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total
Hourly Rate
60.30
562.24
Public works certified Payroll Reporting Form 09/25/2019 - Page 7
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Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER
Employee: JAIME OSUNA 1524 CORONEL ST., SAN FERNANDO, CA, 91340
SSN: 5761
S PLASTER TENDER
NOTE: CHECK# 12948
Sat
08/17
0.00
Sun
08/18
0.00
Mon Tue
08/19 08/20
8.00 8.00
Wed
08/21
8.00
Thu
08/22
8.00
(
Fri
08/23
8.00
Total
Hours
40.00
Base Hourly
60.30
Total
Fringe
0.00
Week Ending: 08/23/2019
Vaci
Holiday
0.00
Health
&Welf.
0.00
Travel & Subsistence
Pension
0.00
0.00
Payroll Number: 1-0
Other Training
0.00 0.00
Total Deductions
Total
Hourly Rate
60.30
541.96
Public works certified Payroll Reporting Form 09/25/2019 -Page 8
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