HomeMy WebLinkAboutRedacted - Waterline 91436 Week 18 ended 01.19.19( 1 ) ( 2)
NAME, AD DRESS AND Number of
SO OAL SECURITY NUMBER Withholding
OF EMPLOYEE Ex""""ion<
Bryce Crespin
4355 Cayucos Ave
Atascadero, CA 93422 0
Iran A Nieves
1628 Village Ct
Santa Maria, CA 93454 0
0
Jacob D Rexford
2761 Chaparral Lane
Paso Robles, CA 93446
James Douglas
612 Laura Way
Paso Robles, CA 93446 0
Jose Sanchez Garcia
558 Ferro Lane
Paso Robles, CA 93446 0
Juan Manuel Barrios
1021 Gaylene Dr
Santa Maria, CA 93458 0
Philip C Brainard III
1355 13th St
Los Osos, CA 93402 0
Ronnie Ramsey
PO Box 141
Cayucos, CA 93430-0410 0
FORM A·l-131 {New 2·80)
diR Callfomla Department
of tndustrlal Relations PUBLIC WORKS PAYROLL REPORTING FORM
NAME OF CON1RACTOR D-KAL Engineering CON1RACTOR'S LICENSE # 653307 ADDRESS
OR SUBCON1RACTOR SPEC IAL TY LICENSE #
PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE# PRO JECT OR CO N1RACT #
18 1/19/2019 WORKERS' COMPENSATION POLICY # 7J45679A18 PROJECT & LOCATION
(4\DAY ( 5) ( 6) ( 7) ( 8)
( 3) Sun Mon Tue Wed I Thu I Fri Sat GROSS AMOUNT
DATE HO URLY EARNED
PAGE
PO Box 1919 San Luis Obisnn CA 93406
Waterline Replace Spec 91436
San Luis Obisoo
( 9)
NET
WAGES
WORK 1/13 1/14 1/15 1116 1117 1118 1/19 TOTAL RATE THIS ALL DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID FOR
CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY PROJECT PR OJECTS WEEK
FWH MCARE FICA ST TAX SDI VAC/HOL HEALTH/WELF PENSION s 0 0 0 7 3 8 0 18 $ 75.23 $ 107.00 ¢ 19.63 $ 83.96 $ 73.61 $ $ $ $ -
Equip. Opers.
Apprentice
Laborer
Laborer
Laborer
Laborer
Laborer
Laborer
Equip. Opers.
D
0
s 0 0
D
0
s 0 0
D
0
s 0 0
D
0
s 0 0
D
0
s 0 0
D
0
s 0 0
D
0
s 0 0
D
0
s
D
0
s
D
0
s
D
0
s
D
0
s =Straight time
0 = Overtime
D = Doubletime
0
0
0
0
0
0
0
$ 1,354.14 $ 1,354.14 "TRAINING fUNDADMIN DUES TRVISUBS
$ -$ $ -$ FWH MCA RE FICA ST TAX
0 0 7 0 7 $ 20.48 $ 1.00 $ 2.42 $ 10.36 $ 1.67
$ 143.36 $ 143.36 "TRAINING FUNDADMIN DUES TRV/SUBS
$ $ $ $
FWH MCARE FICA ST TAX
0 0 4 0 4 $ 55.73 $ 33.00 $ 10.04 $ 42.95 $ 18.17
$ 692.76 $ 692.76 TRAJNING FUNDADMIN DUES TRV/SUBS
$ $ $ . $
FWH MCARE FICA ST TAX
7 0 4 0 11 $ 58.38 $ 50.00 $ 12.55 $ 53.64 $ 18.06
$ 865.10 $ 865.10 TRAJNING FUNDADMIN DUES TRV/SUBS
$ $ $ . $
FWH MCARE FICA ST TAX
0 0 7 0 7 $55.73 $ $ 5.66 $ 24.19 $ 3.90
$ 390.11 $ 390.11 "TRAINING FUNDADMIN DUES TRV/SUBS
$ $ $ . $ fWH MCA RE FICA ST TAX
0 0 7.5 0 7.5 $ 55.73 $ $ 6.06 $ 25.91 $ 4 .18
$ 417.98 $ 417.98 TRAJNING FUNDADMIN DUES TRV/SUBS
$ . $ $ $
FWH MCARE FICA ST TAX
0 0 7 0 7 $ 55.73 $ . $ 5.65 $ 24.19 $ 3.91
$ 390.11 $ 390.11 TRAJNING FUNDADMIN DUES TRV/SUBS
$ . $ $ $
FWH MCA RE FICA ST TAX
7 0 6.5 0 13.5 $ 75.23 $ 95.00 $ 14.73 $ 62.97 $ 40.97
$ 1,015.61 $ 1,015.61 "TRAINING FUNDADMIN DUES TRV/SUBS
$ $ $ . $ FWH MCA RE FICA ST TAX
TRAJNING FUNDADMIN DUES TRViSUBS
FWH MCARE FICA ST TAX
"TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAJNING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
"TRAINING FUNDADM!N DUES TRV/SUBS
* OTHER · Any other deductions, contributions and/or payments whether or not included or req uired by prevailing
wage determina tions must be separately listed. Use extra sheet if necessary.
SAVINGS OTHER TOTAL OED CHKNUM $ 979.94
$ -$ 90.00 $ 374.20 DD3014
SDI VAC/HOL HEAL TH/WELF PENSION
$ $ $ $ -
SAVINGS OTHER TOTAL OED CHKNUM $ 127.91
$ $ .$ 15.45 DD3017
SDI VAC/HOL HEAL TH/WELF PENSION
$ $ $ $ SAVINGS OTHER TOTAL OED CHI( NUM $ 501.24 s . $ 87.36 $ 191.52 DD3018
SDI VAC/HOL HEAL TH/WELF PENSION
$ . $ $ $ .
SAVINGS OTHER TOTAL OED CHK NUM $ 655.85
$ $ 75.00 $ 209.25 DD3019
SDI VAC/HOL HEAL TH/WELF PENSION
$ $ $ $ SAVINGS OTHER TOTAL OED CHI( NUM $ 321.36
$ $ 35.00 $ 68.75 1892
SDI VAC/HOL HEAL TH/WELF PENSION
$ $ $ . $ .
SAVINGS OTHER TOTAL OED CHK NUM $ 344.33
$ $ 37.50 $ 73.65 DD3021
SDI VAC/HOL HEAL TH/WELF PENSION
$ $ $ $ SAVINGS OTHER TOTALDED CHKNUM $ 321.36
$ . $ 35.00 $ 68.75 1893
SDI VAC/HOL HEAL TH/WELF PENSION
$ . $ $ $ SAVINGS OTHER TOTALOEO CHKNUM $ 734.44
$ $ 67.50 $ 281.17 1894
SDI VAC/HOL HEALTH/WELF PENSION
SAVINGS OTHER TOTAL OED CH KNUM
SDI VAC/HOL HEALTH/WELF PENSION
SAVINGS OTHER TOTALDED CHK NUM
SDI VAC/HOL HEAL TH/WELF PENSION
SAVINGS OTHER TOTAL OED CHKNUM
SDI VACIHOL HEAL TH/WELF PENSION
SAVINGS OTHER TOTAL OED CHK NUM
CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com
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