HomeMy WebLinkAboutRedacted Payroll - Week 2019-09-06Public Works Certified Payroll Reporting Form
Contractor Name: AQUA CONSTRUCTION INC. Project Name: S.L.0. SWIM CENTER THERAPY POOL REPLASTER Week Ending: 09/06/2019 Payroll Number: 3-0
Employee: CRISTIAN ZUNIGA ESCOTO 1877 E ROSEWOOD CRT UNIT B, ONTARIO, CA, 91764
SSN: 9467 Sat Sun Mon Tue Wed Thu Fri Total Total Vaci Health Total Hours Base Hourly Fringe Holiday &Welt Pension Other Training Hourly Rate 08131 09/01 09/02 09/03 09/04 09/05 09/06
s PLASTERER 0.00 0.00 8.00 8.00 8.00 8.00 0.00 32.00 60.80 0.00 0.00 0.00 0.00 0.00 0.00 60.80
NOTE: CHECK# 12988 Travel & Subsistence 0.00 Total Deductions 389.29
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Public works certified Payroll Reporting Form 11/15/2019 -Page 2
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 tor the week ending 2019-09-06 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 2019-11-15."
Contractor Name: AQUA CONSTRUCTION INC.
Address: 449 W. FOOTHILL 11272, GLENDORA, CA 91741
Insurance Number: CST5015647
Awarding Body: CITY OF SAN LUIS OBISPO
Contract With: CITY OF SAN LUIS OBISPO
Payroll#: 3 - o Ctr Payroll #:
Contractor PWCR: 1000002113
FEIN: 464958809
DIR Project ID: 298806
County: SAN LUIS OBISPO
Week Ending: 09/06/2019
Employee: JOSE LUIS YEPEZ 7731 LOMBARDY AVE., FONTANA, CA, 92336 I
SSN: 2631
S PLASTERER
NOTE: CHECK# 13006
Sat
08/31
0.00
Sun
09/01
0.00
Mon Tue Wed
09/02 09/03 09104
8.00 8.00 8.00
Thu
09/05
8.00
License Type: CSLB License Number 992227
Contractor Email: NUGGMAN@AOL.COM
Project Name: S.LO. SWIM CENTER THERAPY POOL REPLASTER
Address: 900 SOUTHWOOD, SAN LUIS OBISPO, CA 93401
O Statement of Non-Performance? O Final payroll for this project?
Fri Total Total
09/06 Hours Base Hourly Fringe
0.00 32.00 60.80 0.00
Vaci Health
Holiday &Welf. Pension
0.00 0.00 0.00
Travel & Subsistence 0.00
Other Training
0.00 0.00
Total Deductions
Total
Hourly Rate
60.80
389.29
Pub1ic Works cen:ified Payroll Reporting Form 11/15/2019 -Page 1
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