HomeMy WebLinkAboutRedacted - Waterline 91436 Week 16 ended 01.05.19( 1) ( 2)
NAME, ADDRESS AND NtJrnboro(
SOCIAL SECURITY NUMBER WithholdlnQ
OF EMPLOYEE u-uons
Bryce Crespin
4355 (ayucos Ave
Atascadero, CA 93422 0
Clinton R Barry
776 Brahma St
Paso Robles, CA 93446 0
Iran A Nieves
1628 Village Ct
Santa Maria, CA 93454 0
Jacob D Rexford
2761 Chaparral Lane
Paso Robles, CA 93446 0
0
0
0
0
0
0
James Douglas
612 Laura Way
Paso Robles, CA 93446
James Yanez
538 County Lane
San Luis Obispo, CA 93401
Jose Sanchez Garcia
558 Ferro Lane
Paso Robles, CA 93446
Juan Manuel Barrios
1021 Gaylene Dr
Santa Maria, CA 93458 0
Luis Abarca
13737 Geronimo Rd
SANTA MARGARITA, CA 9345
Ronnie Ramsey
PO Box 141
cayucos, CA 93430-0410 5
FORM A-1-131 (New 2-80)
diR PUBLIC WORKS PAYROLL REPORTING FORM PAGE
NAME OF CONTRACTOR 0-KAL Engineering CONTRACTOR'S LICENSE # 653307 ADDRESS
OR SUBCONTRACTOR SPECIAL1Y LICENSE# PO Box 1919 San Luis Ob1soo CA 93406
PAYROLL NUMBER FOR WEEK ENOING SELF-INSURED CERTIFICATE# PROJECT OR CONTRACT # Waterline Replace Spec 91436
16 1/5/2019 WORKERS' COMPENSATION POLICY # 7J45679Al8 PROJECT & LOCATION San LUIS Obisoo
41 DAY ( 5) ( 6) ( 7) ( 8) ( 9)
( 3) Sun Mon Tue Wed Thu Fri Sat GROSS AMOUNT NET
DATE HOURLY EARN ED WAGES
WORK 12/30 12/31 1/1 1/2 1/3 1/4 1/5 TOTAL RATE nus ALL DEDUCTIONS, CONTRIBUTIONS AND PAY MENTS PAID FOR
CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY PRO JECT PROJECTS
s 0 0
carpenters D
0 0 0
s 0 0
Equip. Opers. D
0 0 0
Apprentice s 0 0
Laborer D
0 0 0
s 0 0
Laborer D
0 0 0
s 0 4
Laborer D
0
� s l �M)cA. D 0 0
0
Laborer
Laborer
Apprent,ce
Laborer
Equip. Opers.
s 0 0
D
0 0 0
s 0 0
D
0 0 0
s 0 0
D
0
s 0 0
D
0
s
D
0
s
D
0
S = Straight time
0 = Overtime
D = Doubletime
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FWH MCARE FICA ST TAX
7 8 0 0 15 $62.02 $ 67.00 $ 14.67 $ 62.76 $ 39.67
$ 1,012.25 $ 1,012.25 TRAINING FUNDADMIN DUES TRV/SUBS
0 1 0 0 1 $ 81.95 $ -$ s -$ -
FWH MCA RE FICA ST TAX
8 8 0 0 16 S 75.23 $ 79.00 $ 19.62 $ 83.86 $ 66.46
$ 1,301.56 $ 1,352.64 TRAINING FUNDADMIN DUES TRV/SU8S
0.5 0.5 0 0 1 $97.88 $ $ -s $ FWH MCA RE FICA ST TAX
8 0 0 0 8 s 20.48 $ 42.00 $ 7.73 $ 33.07 $ 12.22
$ 179.20 $ 179.20 TRAINING FUNDADMIN DUES TRV/SUBS
0.5 0 0 0 0.5 $30.72 $ -$ $ $ FWH MCARE FICA ST TAX
8 8 8 0 24 $55.73 $ 122.00 $ 22.03 $ 94.21 $ 87.85
$ 1,519.65 $ 1,519.65 TRAINING FUNDADMIN DUES TRV/SUBS
1 0.5 1 0 2.5 s 72.85 s $ s -s -
FWH MCA RE FICA ST TAX
0 0 0 0 4 S 55.73 $ 52.00 s 11.93 s 51.02 $ 17.92
$ 222.92 $ 822.92 TRAINING FUNDADMJN DUES TRV/SUBS s $ $ $ -
177.� l�L/0'-<.C FWH MCARE FICA ST TAX
S 408.00 s 43.30 S 185.16 s 255.89
8 8 0 0 16 � $� $ 3,100.00 TRAINING FUNDADMIN DUES TRV/SUBS
$ s s -$ FWH MCARE FICA ST TAX
8 8 8 0 24 $55.73 $ 42.00 $ 20.45 $ 87.44 $ 22.49
$ 1,410.37 $ 1,410.37 TRAINING FUNOADMIN DUES TRV/SUBS
0.5 0.5 0 0 1 S 72.85 $ -$ -$ $
FWH MCA RE FICA ST TAX
8 8 0 0 16 S 55.73 $ 79.00 $ 17.15 $ 73.35 $ 47.03
$ 1,183.08 $ 1,183.08 TRAINING FUNDADMIN DUES TRV/SUBS
1.5 1.5 l 0 4 $ 72.85 $ -$ $ $ -
FWH MCA RE FICA ST TAX
8 8 0 0 16 $ 20.48 $ 33.00 $ 5.53 s 23.68 s 8.55
$ 327.68 $ 327.68 TRAINING FUNDADMIN DUES TRV/SUBS
$ $ $ $
FWH MCA RE FICA ST TAX
8 0 0 0 8 $ 75.23 $ 45.00 $ 8.72 $ 37.31 $ 14.14
$ 601.84 $ 601.84 TRAINING FUNDAOMIN DUES TRV/SUBS
$ s -$ s -
FWH MCA RE FICA ST TAX
TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNOAOMJN DUES TRV/SUBS
• OTHER -Any other deductions, contributions and/or payments whether or not ,ncluded or required by prevailing
wage determ1nat,ons must be separately list ed. Use extra sheet 1f necessary.
WEEK
SDI VAC/HOL HEALTH/WELF PENSION
$ -$ -$ -$
SAVINGS OTHER TOTALDED CHKNUM $ 748.15 s -s 80.00 $ 264.10 002992
SDI VAC/HOL HEALTHIWELF PENSION
$ -$ $ $ SAVINGS OTHER TOTALDED CHKNUM $ 1,018.70
$ $ 85.00 $ 333.94 DD2993
SDI VAC/HOL HEALTHIWEl.F PENSlON
$ $ -$ -$
SAVINGS OTHER TOTAL OED CHKNUM $ 84.18 s -$ -$ 95.02 1882
SDI VAC/HOL HEALTHIWEl.F PENSION
$ $ $ $ SAVINGS OTHER TOTALDED CHKNUM $ 1,033.70
$ -$ 159.86 $ 485.95 DD2997
SDI VAC/HOL HEALTH/Wa.F PENSION s $ $ -$ SAVINGS OTHER TOTAL OED CHKNUM $ 670.05
$ $ 20.00 $ 152.87 DD2998
SDI VAC/HOL HEALTHIWELF PENSION
$ s s -$ -
SAVINGS OTHER TOTALDED CHKNUM $1,994.02
$ $ 213.63 S 1105.98 002999
SDI VAC/HOL HEALTH/WELF PENSION s -s $ $
SAVINGS OTHER TOTALDEO CHKNUM $ 1,495.89
$ -S (257.90) $ (85.52) 1876
SDI VAC/HOL HEALTHIWELF PENSION s s -s $ -
SAVINGS OTHER TOTAL DEO CHKNUM $ 866.55
$ S 100.00 $ 316.53 003000
SDI VAC/HOL HEALTH/WELF PENSlON
$ $ $ $ SAVINGS OTHER TOTALDED CHKNUM $ 256.92
$ $ -$ 70.76 1877
SDI VAC/HOL HEAL THIWELF PENSlON s $ -$ $ .
SAVINGS OTHER TOTAL OED CHKNUM $ 456.67
$ $ 40.00 s 145.17 1879
SDI VAC/HOL HEALTH/WELF PENSlON
SAVINGS OTHER TOTAL OED CHKNUM
SDI VAC/HOL HEALTH/WELF PENSION
SAVINGS OTHER TOTAL DED CHKNUM
CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com
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