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Home My WebLink AboutCertified Payroll 07.25.2019 Task 01&02 - Bunyon BrosNOTICE TO PUBLIC ENTITY I, Brandi Amundson undersigned, am (Name -print) -'O""'ffi"'"'1-"-ce"-"-'M"'"'a=nc.ca=g~e-'-r ______________ with the authority to act for and on behalf of (Position in Business) -=B=u=n"-'y-=o-'-'n...,B=r-=o-=-s .,_. T-'-'-'re""e~S=-e=rv'--'-'-'ic""e'---------------'' certify under penalty of perjury that (Name of business and/or contractor) the records or copies thereof submitted and consisting of Certified Payrol l, 9 pages (Description, No. of Pages) 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 . Date: 07/31/2019 Signature:~~ A public entity may require a more strict and/ or more extensive forn;i. of certification. ,/ / ._ STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION . STATEMENT OF COMPLIANCE CEM-2503 (REV 8/1996) CONTRACTOR /SUBCONTRACTOR BUNYO BROS. TREE SERVICE FIRST DAY AND DATE OF PAY PERIOD Monday, 07 /22 /20 l 9 I do hereby certify under penalty of perjury : CONTRACT NUMBER DIR 72276 I INV 2067 1 LAST DAY AND DATE OF PAY PERIOD Sunday, 07 /28 /2019 ( 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 earned by any person other than permissible deductions . (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) D Specified in the applicable wage determination incorporated into the contract; (b) [8] Determined by the Director oflndustrial 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. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency. (4) That fringe benefits as listed in the contract: (a) D 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) [8] Have been paid directly to the listed employee(s), except as noted below. (c) D See exceptions noted below. Senior Tree Trimmer Training fees paid to CA Apprenticeship Council REMARKS : NAME (PLEASE PRINT.) TITLE Office Manager DATE 07/31/2019 On federally -funded projects, permissible deductions are defined in title 29 , Code of Federal Regulations, part 3, issued by the Secretary of Labo r 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 oftitle 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) 654-641 O or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89 , Sacramento , CA 95814 . ceM 2503 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STATEMENT OF COMl=>LIANCE CEM-2503 (REV 8/96) INSTRUCTIONS This statement of compliance meets needs of the state and federal payroll requirements to pay fringe benefits in addition to payment of the minimum rates . The contractor's obligation to pay fringe benefits may be met by payment of the fringes to the various preapproved plans , funds , or programs or by making these payments directly to the employees as part of their weekly wage payments . The contractor must show on the face of his or her payroll all monies paid to the employees whether as basic rates or total hourly wage amount in lieu of fringes . The contractor shall report in the statement of compliance that he or she is paying to others fringes required by the contract and not paid directly to the employees in lieu of fringes . Detailed instructions follow : Contractors required to pay Federal Wage Rates: Such a contractor shall check paragraph 2(a) of the statement to indicate that the wage rates for laborers or mechanics contained in the payroll are not less than the applicable wage rates specified in the applicable wage determination incorporated into the contract. Contractors required to pay the State Prevailing Wage Rates as determined by the Director of Industrial Relations: Such a contractor shall check paragraph 2(b) of the statement to indicate that the wage rates for laborers or mechanics contained in the payroll are not less than the applicable wage rates determined by the Director of Industrial Relations for the county or counties in which the work is preformed . Contractor who pay all required fringe benefits: A contractor who pays fringe benefits to approved plans , funds , or programs in amounts not less than were determined in the applicable wage decisions shall continue to show on the face of his or her payroll the basic hourly rate and overtime rate paid to his or her employees , just as he or she has always done. Such a contractor shall check paragraph 4(a) of the statement to indicate that he or she is also paying approved plans , funds , or programs within the times required for the receipt of those sums , not less than the amount predetermined as fringe benefits for each craft . Any excepti on shall be noted in Section 4(c). Contractors who pay no fringe benefits: A contractor who does not pay fringe benefits to an approved plan shall pay a like amount to the employee. This payment can be reported by inserting in the straight time hourly rate column of his or her payroll an amount not less than the predetermined rate for each classification plus the amount of fringe benefits determined for each classification in the applicable wage decision . Inasmuch as it is not necessary to pay time and a half on wages paid in lieu of fringes , the overtime rate shall be not less than one and one-half the basic predetermined rate , plus the required cash in lieu of fringes at the straight time rate. To simplify computation of overtime , it is suggested that the straight time basic rate and payment in lieu of fringes be separately stated in the hourly rate column . In addition , the contractor shall check paragraph 4(b) of the statement to indicate that he or she is paying fringe benefits directly to his or her employees. Any exceptions shall be noted in Section 4(c). Use of Section 4(c), Exceptions: Any contractor who is making payment to approved plans , funds , or programs in amounts less than the wage determination required is obligated to pay the deficiency directly to the employees as wages in lieu of fringes. Any exceptions to Section 4(a) and 4(b), whichever the contractor may check , shall be entered in Section 4(c). Enter in the Exception column the craft , and enter in the Explanation column the hourly amount paid the employees as wages in lieu of fringes , and the hourly amount paid to plans , funds , or programs as fringes . 11\ NAME, ADDRESS , ANO SOCIAL SECURITY NUMBER OF EMPLOYEE Conra do Morales 4831 Almaguer Street Guadalupe , CA 9J.43.4 XXX-XX-6714 David Martinez Sandoval 514 N. Lincoln SL , Apl B Santa Maria , CA 93458 XXX-XX-9912 Bartolo Hernandez 1044 Barnett.St Santa Maria , CA 93458 XXX-XX-5534 Ramiro Sosa Garcia 1743 Vicente Road San Luis Obispo , CA 93405 XXX-XX-5870 CSU .LC-01 I I NAME OF CONTRACTOR : I OR SUBCONTRACTOR: :PAYROLL NO: (3) I i~! I WORK CLASSIFICATION H~l I I I Tree Trimmer I I I I I 21 I I Tree Trimmer I I I I I 01 I I Tree Trimmer I I I I I ol I I Tree Trimmer I I I I I sl S•StralghtTlme O•Overtime s 0 s 0 s 0 s 0 SDl•State Disability Insurance ##### PAYROLL REPORTING FORM ,,.,,. al ---- City of San Luis Obispo CONTRACTOR'S LICENSE NO: 996862 ADDRESS : 5345 Davenport Creek Road Bu nyon Bros. Tree Service SPECIAL TY LIC ENSE NO : Certified Arllorist #WE9252A San Luis Obispo , CA 93-401 FOR WEEK ENDING: 7/28/2019 SELF-INSURED CERTIFICATE NO: PROJECT OR CONTRACT NO : 1000003 INV 20733 & 20734 (4) (5) (6) DIR ID NUMBER : 281745 -Maintenance DAY WORKERS' COMPENSATION POLICY NO : BUWC915499 PROJECT ANO LOCATION : TASK 01/CIP SPEC#:1000023 & 02/CIP SPEC#: 9156 M T w TH F s s HOURLY (7) (8) (9) DATE TOTAL RATE OF GROSS AMOUNT NET WAGES 22-Jul I 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28-Jul HOURS PAY EARNED DEDUCTIONS , CONTRIBUTIONS ANO PAYMENTS PAID FOR CHECK HOURS WORKED EACH DAY THIS ALL PROJECT PROJECTS 9 9.00 38 .00 342 .0( 1,627.35 0.00 57 .00 THIS ALL PROJECT PROJECTS 9 9.00 26 .97 242 .7' 948.54 0.00 36 .85 THIS ALL PROJECT PROJECTS 9 9.00 26 .97 242.7 879 .61 0.00 36 .85 THIS ALL PROJECT PROJECTS 9 9.00 26 .97 242.7 728.88 0.00 38 .85 •OTHER -Any other deductions , contributions , and/or payment whether or not Included or required by prevailing wage determinations must be separetety listed. Use extra sheet if necessary . FICA FED. TAX (SOC. 150.90 124 .50 TRAING . FUND AOMIN FICA FE D. TAX (SOC. 69.44 72 .56 TRAING . FUND ADMIN FICA FED . TAX (SOC. 63.98 67 .28 TRAING . FUND ADMIN FICA FED. TAX ___ (S~:..._. 1.73 55.76 TRAING. FUND AOMIN WEEK NO. STATE VACI HEALTH& SDI PENSION TAX HOLIDAY WELFARE 51 .52 1627 0.00 1,164.40 50936 DUES TRAV/ SAVINGS OTHER' TOTAL DE· SUBS . OUCTIONS 119.76 462.95 STATE VACI HEALTH & Sot PENSION TAX HOLIDAY WELFARE 14.76 9.49 78229 6262500783 DUES TRAV/ SAVINGS OTHER' TOTAL DE· SUBS . DUCTIONS 16625 STATE VACI HEALTH& TAX SDI HOLIDAY WELFARE PENSION 21 .08 8.80 0.00 718 .47 6262500780 DUES TRAV/ SAVINGS OTHER' TOTAL OE- SUBS. OUCTIONS 161 .14 STATE VACI HEALTH& TAX SDI HOLIDAY WELFARE PENSION 6.16 729 657 .94 6262500788 DUES TRAV/ SAVINGS OTHER' TOTAL DE- SUBS . OUCTIONS 70 .94 Statement of Compfiance (CSU .LC-02) f!Yll also be completed . ##### PAYROLL REPORTING FORM I --- I NAME OF CONTRACTOR: City of San Luis Obispo CONTRACTOR'S LICENSE NO: 996862 ADORE SS: 5345 Davenport Cree k Road OR SUBCONTRACTOR : Bunyon Bros. Tree Service SPECIAL TY LICENSE NO: Certified Arborist #WE9252A San Luis Obispo , CA 93401 ,PAYROLL NO: FOR WEEK ENDING : 7/28/2019 SELF-INSUR ED CERTIFICATE NO : PROJECT OR CONTRACT NO: 1000003 INV 20733 & 20734 l1l (3) (4) (5) (6) DIR ID NUMB ER: 2817-45 -Maintenance ~ f DAY WORKERS' COMPENSATION POLICY NO : BUWC915499 PROJECT AND LOCATION : TASK 01/CIP SPEC#:1000023 & 02/CIP SPEC#: 9156 NAME, ADDRESS, AND WORK M T w TH F s s HOURLY (7) (8) (9) SOCIAL SECURITY NUMBER i 11 I CLASSIFICATION DATE TOTAL RATE OF GROSS AMOUNT NET WAGES ~~ I OF EMPLOYEE !1 I 22-Jul 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28.Jul HOURS PAY EARNED DEDUCTIONS , CONTRIBUTIONS AND PAYMENTS PAID FOR CHECK I HOURS WORKED EACH DAY WEEK NO. I THIS ALL FICA STATE VACI HEALTH& PROJECT PROJECTS FED. TAX 1 ........ csoc. TAX SDI HOLIDAY WELFARE PENSION I Tree Trimmer Conrado Morales 0.00 38.00 I s -4831 Almaguer Street 165.06 133.51 59 .30 17.45 0.00 Guada lupe , CA 93434 I 1,250.26 50950 I 19.00 1,745.34 TRAING . FUND DUES TRAVI SAVINGS OTHER• TOTAL DE- XXX-XX~714 I Tree Trimmer AOMIN SUBS . DUCTIONS 1 1.00 19.00 I 0 119.76 495 .08 21 I THIS ALL FICA STATE VACI HEALTH & FED. TAX (SOC. SOI PENSION I LaborerG -1 PROJECT PROJECTS TAX HOLIDAY WELFARE 0.5 0.50 30.81 David Martinez Sandoval I s 514 N. Lincoln St., Apt B I 69.73 72 .75 14.87 9.51 Santa Maria , CA 93458 784 .11 6262500798 I 25 .28 950.97 TRAING . FUND DUES TRAVI SAVINGS OTHER• TOTAL DE- XXX-XX-9912 I Tree Trimmer AOMIN SUBS . DUCTIONS 1 1.00 9.87 I 0 ol 166.86 I THIS ALL FICA STATE VACI HEALTH & I PROJECT PROJECTS FED . TAX (SOC. TAX SDI HOLIDAY WELFARE PENSION LaborerG-1 0.5 0.50 30.81 Banolo Hernandez I s 1044 Barnett st I 60 .18 84 .88 18.99 8.48 0.00 Santa Maria , CA 93458 I 695 .46 6262500795 2526 847.99 TRAING . FUND DUES TRAVI SAVINGS OTHER· TOTAL DE- XXX-XX-5534 I Tree Trimmer AOMIN SUBS . DUCTIONS I 1 1.00 9.88 0 ol 152.53 I THIS ALL FICA STATE VACI HEALTH & I PROJECT PROJECTS FED . TAX (SOC. TAX SDI HOLIDAY WELFARE PENSION Tree Trimmer Ramiro Sosa Garcia I 0.00 26 .97 s 1743 Vicente Road I 0.00 51 .30 4.87 6 .71 San Luis Obispo, CA 93405 607 .75 6262500803 I 9.88 670 .63 TRAING . FUND DUES TRAV/ SAVINGS OTHER• TOTAL DE- XXX-XX-5870 I Tree Trimmer AOMIN SUBS. DUCTIONS I 1 1.00 9.88 0 61 62 .88 S•Straight Time '"OTHER -Any other deductions, contributions, and/or payment whether or not included or required by prevailing Statement of Comphance (CSU .LC-02) .MY.ll &150 be completed . CSU.LC-0 1 O•Overtime wage determinations must be separatety listed . Use extra sheet If necessary. SOl•State Disability Insurance OTHER DEDUC T IONS CONTRACTOR/SUBCONTRACTOR (PLEASE PRINT) PROJECT OR CONTRA CT NO: DIR 10 NUMBER : DATE Bun on Bros. Tree Service INV 20733 & 20734 281745 -Maintenance 7/31/2109 TO: CONSTRUCTION ADMINISTRATOR/LABOR COMPLIANCE MANAGER ADDRESS 5345 Davenport Creek Rd .. San Lu is Obispo , CA 93401 Employee: Other Deductions Desc : Amount Total Per Employee CONRRADO MORALES GARNISHMENT 119.76 119.76 I cerlify under penalty of perjury that fringe benefits are paid to the approved Plans, Funds, or Programs as listed above. The California State University, Office of the Chancellor Capital Planning , Design and Construction 401 Golden Shore Long Beach , CA 90802-4210 BUSINESS TELEPHONE NUMBER (Area Code flf$l) eos.54M903 Web Site: www calstate.edu/cpdc/cm/L abor Compliance Labor Compliance Manager Phone: (562) 951-4100 Fax: (562) 951-4921 Email: cocm@calstate.edu FRINGE BENEFIT STATEMENT 281745-Maintenance 7/31/2019 5345 Davenport Creek Rd., San Luis Obispo , CA 93401 The following information (as shown or referenced on wage rate determinations) paid to or on beha lf of employees in various crafts or classifications is used to check payrolls or applied to force account work on the above contract. THIS FORM MUST BE COMPLETED AND SUBMITIED WITH THE FIRST CERTIFIED PAYROLL OR WHEN THERE HAVE BEEN ANY CHANGES. CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0 .00 Conrado Morales4831 Alma! Anthem Blue Cross Health & PO Box 51011 8/22/2018 Welfare $ 0 .00 Los Angeles , CA 90051-5311 Operator G-8 Pension $ 0 .00 State of CA DIR CA Apprenticeship Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Training $ 0 .69 Los Angeles , CA 90051 -7838 $ Other $ 0 .00 CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0 .00 David Martinez Sandova l51' Anthem Blue Cross Health & PO Box 51011 8/22/2018 Welfare $ 0 .00 Los Angeles , CA 90051-5311 Tree Trimmer Pension $ 0 .00 State of CA DIR CA Apprenticeship Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Tra ining $ 0 .69 Los Angeles, CA 90051-7838 $ Other $ CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0 .00 Bartolo Hernandez1044 Ba n Anthem Blue Cross Health & PO Box51011 8/22/2018 Welfare $ 0.00 Los Angeles , CA 90051-5311 Tree Trimmer Pension $ 0.00 State of CA DIR CA Apprenticesh ip Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Training $ 0.69 Los Angeles , CA 90051-7838 $ Other $ I certify under penalty of pef]ury that frmge benefits are paid to the approved Plans, Funds, or Programs as listed above. NAME ANO TITLE (Please Print) Brand i Amundson -Office Mana er The California State Un iversity, Office of the Chancellor Capital Planning , Design and Construction 401 Golden Shore BUSINESS TELEPHONE NUMBER (Area Code first) 805-547-1903 Long Beach , CA 90802-4210 Web Site: www.calstate .edu/cpdc/cm/Labor Compliance labor Compl iance Manager Phone: (562) 951-4100 Fax: (562) 951-4921 Email : cocm@calstate .edu Revised '2//20/0 FRINGE BENEFIT STATEMENT 281745 -Maintenance 7/31/2019 5345 Davenport Creek Rd ., San Luis Obispo , CA 93401 The following information (as shown or referenced on wage rate determinations) pa id to or on behalf of employees in various crafts or classifications is used to check payrolls or applied to force account work on the above contract. THIS FORM MUST BE COMPLETED AND SUBMITIED WITH THE FIRST CERTIFIED PAYROLL OR WHEN THERE HAVE BEEN ANY CHANGES . CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0.00 Ramiro Sosa Garcia1743 Vi , Anthem Blue Cross Health & PO Box 51011 8/22/2018 Welfare $ 0 .00 Los Angeles, CA 90051-5311 Tree Trimmer Pension $ 0 .00 State of CA DIR CA Apprenticeship Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Training $ 0.69 Los Angeles, CA 90051 -7838 $ Other $ 0 .00 CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0.00 Anthem Blue Cross Health & PO Box 51011 8/22/2018 Welfare $ 0 .00 Los Angeles, CA 90051-5311 LaborG-2 Pension $ 0 .00 State of CA DIR CA Apprenticeship Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Training $ 0 .69 Los Angeles, CA 90051-7838 $ Other $ CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN , FUND OR PROGRAM Effective Date Vacation $ 0.00 Anthem Blue Cross Health & PO Box 51011 8/22/2018 Welfare $ 0 .00 Los Angeles, CA 90051-5311 Labor G-2 Pension $ 0 .00 State of CA DIR CA Apprenticeship Council Apprentice/ PO Box 511283 Subsistence and/or Travel Pay Training $ 0 .69 Los Angeles, CA 90051-7838 $ Other $ I certify under penalty of peryury that fnnge benefits are paid to the approved Plans, Funds, or Programs as ltsted above. NAME ANO TITLE (Please Prtnt) The Ca lifornia State Un iversity, Office of the Chancellor Capital Planning , Design and Construction 401 Golden Shore BUSINESS TELEPHONE NUMBER (Area Code first) 805-547-1903 Long Beach , CA 90802-4210 Web S ite: www.calstate.edu/cpdc/cm/Labor Compliance Labor Compliance Manager Phone: (562) 951-4100 Fax: (562) 951-4921 Email: cocm@calstate.edu Revised '2 11201 0 7/31/2019 eCPR Form Appl icati on eCPR Online Confirmation Your payroll submission request has been processed. Please review the results of your submission . Should you have any questions please contact the eCPR unit at publicworks@dir.ca.gov. Contractor Name : BUNYON BROS TREE CARE INC. Contractor Address : 5345 DAVENPORT CREEK RD . SAN LUIS OBISPO CA 934 0 1 Awarding Body : CITY OF SAN LUIS OBISPO Project ID : 281745 Contract With : BUNYON BROS TREE CARE INC . Week Ending Date: 2019-07-28 Payroll Number: 1 Amendment Number: 0 4 employee payroll record (s) processed Your Transaction ID is : 6211585 Print th is Pagg View your submission https ://efi lin g .dir.ca.gov/e CP R/pages/e CP ROnlineForm .jsp 1/1 7/31/2019 TRAINING FUND CONTRIBUTIONS California Apprenticeship Council Please Mail this form and your check payable to the California Apprenticeship Council to: State of California Department of Industrial Relations California Apprenticeship Council P.O. Box 511283 Los Angeles, CA 90051-7838 Report Period: 7/22/2019 to 7/28 /2019 Contract/Project No: DIR 281745 Jobsite: Remittance for the Following Projects COUNTY SAN LUIS OBISPO CLASSIFICATION UNKNOWN OCCUP Submitter Contact Information Submitter's name Brandi Amundson Generated: 7 /31 /2019 Submitter's title Office Manager https ://www.dir.ca.gov/das/tf/CAC2-I NV.asp?actio n=captcha Apprenticeship Training Fund Invoice HOURS 36.00 Transaction ID: Total Amount: 766537 $24.84 Contractor License: 996862 Contractor's Name & Address: Bunyon Bros. Tree Care, Inc. 5345 Davenport Creek Rd. SAN LUIS OBISPO, CA 93401 CONTRIBUTION RATE $0.69 Email address contact@bunyonbros.com Phone# 8055471903 AMOUNT $24.84 1/1