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Home My WebLink AboutRedacted - Waterline 91436 Week 19 ended 01.26.19( 1) NAME, ADDRESS AND SOCIAL SECURITY NUMBER OF EMPLOYEE Bryce Crespin 4355 (ayucos Ave Atascadero, CA 93422 Bryce Crespin 4355 cayucos Ave Atascadero, CA 93422 Clinton R Barry 776 Brahma St Paso Robles, CA 93446 George Llamas 800 E. Cook Santa Maria, CA 93454 Jacob D Rexford 2761 Chaparra l Lane Paso Robles, CA 93446 Jacob D Rexford 2761 Chaparral Lane Paso Robles, CA 93446 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 Juan Manuel Barrios 1021 Gaylene Dr Santa Maria, CA 93458 Manuel Robledo 9694 B irmingham Ave Riverside, CA 92509 FORM A-1-131 (New 2-80) ( 2) Number of diR c.a1irom1a Department of lnclustnal Relations PUBLIC WORKS PAYROLL REPORTING FORM NAME OF CONTRACTOR D-KAL Enginee rin g CONTRACTOR'S UCENSE # 653307 ADDRESS OR SUBCONTRACTOR SPECIAL lY UCENSE # PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE# PROJECT OR CONTRACT # 19 1/26/2019 WORKERS' COMPENSATION POUCY # 7J45679A18 PROJECT & LOCATION 41 DAY ( 5) ( 6) ( 7) ( 8) ( 3) Sun Mon Tue Wed Thu Fri Sat GROSS AMOUNT DATE HOURLY EARNED PAGE PO Box 1919 San Luis Obisoo. CA 93406 Waterline Replace Spec 91436 San Luis Obisoo ( 9) NET WAGES Wlthholdlng WORK 1/20 1/21 1/22 1/23 1/24 1/25 1/26 TOTAL RATE THIS ALL DEDUCTIONS, CONTRIBLJTIONS AND PAYMENTS PAID FOR Ex emotions 0 0 0 0 0 0 0 0 0 0 0 0 CLASSIFlCATION HOURS WORKED EACH DAY HOURS OF PAY PROJECT PROJECTS Equip. Opers. Laborer Equip. Opers. Teamsters Carpenters Laborer Laborer Foreperson Laborer carpenters Laborer Laborer s 0 0 D 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s D 0 0 0 s 0 0 D 0 0 0 s 0 0 D 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 S = Strai ght time 0 = Overtime D = Doubletime 6 0 0 8 0.5 0 0 5 0 3 2.5 8 0 0 0 0 0 8 1 8 0 FWH MCA RE FICA ST TAX 0 3 2 0 11 $ 75.23 $ 189.00 $ 29.28 $ 125.18 $ 144.20 $ 827.53 $ 2,019.15 TRAINING RJNOAOMIN DUES TRV/SUBS $ -$ $ $ FWH MCA RE FlCA ST TAX 0 5 6 0 11 $62.02 $ 189.00 $ 29.28 t 125.18 $ 144.20 $ 991.62 $ 2,019.15 TRAINING FUNOAOMIN DUES TRV/SUBS 0 2 2 0 4 s 77.35 $ -$ -$ $ - FWH MCA RE FlCA ST TAX 0 0 0 0 8 $ 75.23 $ 133.00 $ 25.54 $ 109.21 $ 116.73 $ 651.51 $ 1,761.51 TRAINING FUNOADMIN DUES TRV/SUBS 0 0 0 0 0.5 $99.33 $ -$ -$ -$ - FWH MCA RE FlCA ST TAX 0 0 8 0 8 $ 59.91 $ 374.00 $ 33.56 $ 143.50 $ 176.85 $ 705.33 $ 2,314.51 TRAINING FUNDAOM!N DUES TRV/SUBS 0 0 3 0 3 s 75.35 $ $ $ -$ FWH MCARE ACA ST TAX 8 0 0 0 13 $62.02 $ 266.00 $ 35.26 $ 150.77 $ 184.15 $ 929.19 $ 2,431.81 TRAINING FUNDAOM!N DUES TRV/SUBS 1.5 0 0 0 1.5 $ 81.95 $ $ $ -$ FWH MCA RE ACA ST TAX 0 8 8 0 19 $ 58.73 $ 266.00 $ 35.26 $ 150.77 $ 184.15 $ 1,502.62 $ 2,431.81 TRAINING RJNDADM!N DUES TRV/SUBS 0 0.5 2 0 5 $ 77.35 $ $ $ -$ FWH MCARE ACA ST TAX 8 8 8 0 32 $55.73 $ 167.00 $ 27.97 S 119.60 $ 79.50 $ 1,929.06 $ 1,929.06 TRAINING RJNDADM!N DUES TRV/SUBS 0.5 0.5 1 0 2 $ 72.85 $ $ $ $ FWH MCA RE FICA ST TAX $ 426.00 $ 43.30 S 185.15 S 258.39 0 8.5 10 0 18.5 $ 77.50 $ 1,433.75 $ 3,100.00 TRAINING RJNDADM!N DUES TRV/SUBS $ $ $ $ FWH MCA RE ACA ST TAX 0 0 8 0 8 $ 55.73 $ 60.00 $ 22.87 $ 97.81 $ 31.70 $ 518.69 $ 1,577.56 TRAINING FUNOAOM!N DUES TRV/SUBS 0 0 l 0 1 $ 72.85 $ -$ $ $ FWH MCARE FICA ST TAX 8 0 0 0 8 $62.02 $ 196.00 $ 25.81 $ 110.36 $ 109.59 $ 496.16 $ 1,779.97 TRAINING FUNDADMIN DUES TRV/SUBS $ $ $ -$ - FWH MCARE FICA ST TAX 0 0 8 0 16 $ 55.73 $ 196.00 $ 25.81 $ 110.36 $ 109.59 $ 1,073.81 $ 1,779.97 TRAINING FUNDADM!N DUES TRV/SUBS 0 0 1.5 0 2.5 $ 72.85 $ $ -$ $ - FWH MCARE ACA ST TAX 8 8 0 0 24 $62.02 $ 46.00 $ 16.19 $ 69.24 $ 16.62 $ 1,570.43 $ 1,570.43 TRAINING FUNDADM!N DUES TRV/SUBS 0 1 0 0 1 $81.95 $ $ $ -$ - • OTHER -Any other deductions, contributions and/or payments whether or not inclu ded or required by prevailing wage determinations must be separately listed. Use extra sheet if necessary. WEEK SDI VAC/HOL HEAL TH/WEI.F PENSION $ $ $ $ SAVINGS OTHER TOTAL OED CHK NUM $ 1,401.49 $ -$ 130.00 $ 617.66 003024 SDI VAC/HOL HEALTH/WELF PENSION $ $ $ $ - SAVINGS OTHER TOTAL OED CHKNUM $1,401.49 $ $ 130.00 $ 617.66 003024 SDI VAC/HOL HEAL TH/WELF PENSION $ $ $ $ - SAVINGS OTHER TOTAL OED CHKNUM $ 1,334.53 $ -$ 42.50 $ 426.98 003025 SDI VAC/HOL HEALTHJWELF PENSION $ $ $ $ - SAVINGS OTHER TOTAL OED CHKNUM $ 1,451.60 $ $ 135.00 $ 862.91 003028 SDI VAC/HOL HEAL TH/WELF PENSION $ -$ $ $ SAVINGS OTHER TOTALDED CHKNUM $ 1,575.77 $ $ 219.86 $ 856.04 003029 SDI VAC/HOL HEALTH/WELf PENSION $ $ $ $ SAVINGS OTHER TOTAL OED CHKNUM $ 1,575.77 $ $ 219.86 $ 856.04 003029 SDI VAC/HOL HEALTH/WELP PENSION $ $ $ $ SAVINGS OTHER TOTAL OED CHKNUM $1,364.99 $ $ 170.00 $ 564.07 003030 SDI VAC/HOL HEALTH/WELP PENSION $ $ $ $ - SAVINGS OTHER TOTAL OED CHKNUM $ 1,973.53 $ $ 213.63 $ 1 126.47 003031 SDI VAC/HOL HEAL TH/WELF PENSION $ $ $ -$ - SAVINGS OTHER TOTALDED CHK NUM $1,225.18 $ $ 140.00 $ 352.38 1896 SDI VAC/HOL HEALTH/WELF PENSION $ -$ $ -$ - SAVINGS OTHER TOTAL OED CHK NUM $ 1,205.71 $ -$ 132.50 $ 574.26 003032 SDI VAC/HOL HEAL TH/WELF PENSION $ -$ $ -$ SAVINGS OTHER TOTALDED CHl<NUM $ 1,205.71 $ $ 132.50 $ 574.26 003032 SDI VAC/HOL HEAL TH/WELF PENSION $ -$ $ -$ SAVINGS OTHER TOTALDED CHl<NUM $ 843.70 $ $ 578.68 $ 726.73 1897 CERTIFICATION must be completed (see back) Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com ( 1 ) ( 2) NAME, ADDRESS AND Number of SOCIAL SECURITY NUMBER Withhold Ing OF EMPLOYEE Exemctlons Philip C Brainard Ill 1355 13th St Los Osos, CA 93402 Philip C Brainard III 0 0 1355 13th St Los Osos, CA 93402 Ronnie Ramsey PO Box 141 Cayucos, CA 93430-0410 FORM A-1-131 (New 2-80) diR C.lltbmla Department of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM PAGE NAME OF CONTRACTOR D-KAL Engineering OR SUBCONTRACTOR PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE # 19 112612019 WORKERS' COMPENSATION POLICY # 41 DAY ( 3) Sun Mon I Tue Wed Thu Fri DATE WORK 1120 1121 1122 1123 1/24 1/25 CLASSIFICATION HOURS WORKED EACH DAY Carpenters Laborer Equip. Opers. s 0 0 D 0 s 0 0 D 0 0 0 s 0 0 D 0 0 0 s D 0 s D 0 s D 0 s D 0 s D 0 s D 0 s D 0 s D 0 s D 0 S = Straight time O = Overtime 4 8 0 0 4 0 8 8 1.5 0 1 1 8 8 8 8 0 0.5 0.5 1 ( 5) ( 6) Sat HOURLY 1/26 TOTAL RATE HOURS OF PAY 0 12 <62.02 0 20 $55.73 0 3.5 $ 72.85 0 32 t 75.23 0 2 t99.33 CONTRACTOR'S LICENSE # SPECIAL TY LICENSE # 7J45679A18 ( 7) GROSS AMOUNT EARNED THIS ALL PROJECT PROJECTS FWH $ 259.00 $ 744.24 $ 2,113.82 TRAINING $ FWH $ 259.00 $ 1,369.58 $ 2,113.82 TRAINING $ FWH $ 436.00 $ 2,606.02 $ 2,606.02 TRAINING $ FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING FWH TRAINING 653307 ADDRESS PO Box 1919 San Luis Obis� CA 93406 PROJECT OR CONTRACT # Waterline Replace Spec 91436 PROJECT & LOCATION San Luis Obisno ( 8) ( 9) NET WAGES DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID FOR WEEK MCA RE FICA ST TAX SDI VAC/HOL HEAL TH/WELF PENSION <; 30.65 $ 131.05 $ 142.47 $ $ -$ <!; - FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTALDEO CHKNUM $1,373.15 t t -$ -$ $ 177.50 I 740.67 1898 MCARE FICA ST TAX SDI VAC'JHOL HEALTH/WELF PENSION t 30.65 $ 131.05 $ 142.47 $ $ ( -,t FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHl<NUM $ 1,373.15 $ $ -$ -$ -$ 177.50 t 740.67 1898 MCA RE FICA ST TAX SDI VAC/HOL HEALTHIWELF PENSION $ 37.78 $ 161.58 $ 206.01 $ $ -t -$ FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTALDEO CHKNUM $1,594.65 $ $ -$ -$ $ 170.00 t 1 011.37 1899 MCARE FICA ST TAX SDI VAC/HOL HEALTH/WELF PENSION FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHl<NUM MCA RE FICA ST TAX SDI VAC/HOL HEALTH/WELF PENSION FUNDADMIN DUES TRVISUBS SAVINGS OTHER TOTALDEO CHK NUM MCA RE FICA ST TAX SDI VAC/HOL HEALTHIWELF PENSION FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM MCARE FICA ST TAX SDI VAC/HOL HEAL THIWELF PENSION FUNDADM!N DUES TRV/SUBS SAVINGS OTHER TOTALDED CHl<NUM MCA RE FICA ST TAX SDI VAC/HOL HEALTHIWELf PENSION FUNDAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM MCA RE FICA ST TAX SDI VAC/HOL HEALTH/WELF PENSION FUND ADM!N DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM MCA RE FICA ST TAX SDI VAC/HOL HEALTI-1/WELF PENSION FUNDADM!N DUES TRVISU8S SAVINGS OTHER TOTALDED CHI< NUM MCA RE FICA ST TAX SDI VAC/HOL HEAL TH/WELF PENSION FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTALDED CHKNUM MCA RE FICA ST TAX SDI VAC/HOL HEAL T><IWELF PENSION FUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM 2 D = Doubletime * OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately li sted. 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