HomeMy WebLinkAboutRedacted - Waterline 91436 Weeks 12,13,14-12.2.18-12.22.18( 1) ( 2)
NAME, ADDRESS AND Number of
SOCIAL SECURITY NUMBER WlthllOldlng
OF EMPLOYEE Exemotlons
Anthony E Lopez Ramirez
2912 lopez Dr
Arroyo Grande, CA 93420 0
0
Bryce Crespin
4355 Cayucos Ave
Atascadero, CA 93422
Bryce Crespin
4355 Cayucos Ave
Atascadero, CA 93422 0
0
0
0
George Llamas
800 E. Cook
Santa Maria, CA 93454
George Llamas
800 E. Cook
Santa Maria, CA 93454
James Douglas
612 Laura Way
Paso Robles, CA
93446
Juan Manuel Barrios
1021 Gaylene Dr Santa
Maria, CA 93458 0
Philip C Bra inard III
1501 14th St
Los Osos, CA 93402 0
Ronnie Ramsey
PO Box 141
Cayucos, CA 93430-0410 0
Timothy D Ambrosi
1199 W Hwy 246 #C
Buellton, CA 93427 0
0
Todd McDonald
PO Box 19068
Reno, NV 98511 ·9998
FORM A· 1 • 131 (New 2·80)
diR California Department
of ln0Jstr1al Re:SaUOns PUBLIC WORKS PAYROLL REPORTING FORM PAGE
NAME OF CONTRACTOR D·KAL Engineering
OR SUBCONTRACTOR
PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE #
12 12/8/2018 WORKERS' COMPENSATION POLICY#
4)DAY
( 3) Sun Mon Tue Wed Thu Fri
DATE
WORK 12/2 12/3 12/4 12/5 12/6 12/7
CLASSIFICATION HOURS WORKED EACH DAY
Apprentice
Laborer
Equip. Opers.
Laborer
Teamsters
Laborer
Laborer
Laborer
Laborer
Equip. Opers.
Equip. Opers.
Laborer
s 0 0
D
0 0 0
s 0 6
D
0
s 0 2
D
0 0 2
s 0 0
D
0
s 0 0
D
0 0 0
s 0 2
D
0 0 2.5
s 0 0
D
0 0 0
s 0 8
D
0 0 2
s 0 2
D
0 0 3
s 0 0
D
0 0 0
s 0 8
D
0 0 2
s
D
0
S = Straight time o = Overtime
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 8 8
0 3 1
0 0 0
0 0 0
0 0 0
0 6.5 0
0 1.5 0
0 2 0
0 8 8
0 3 1.5
0 8 8
0 4 1.5
0 8 8
0 3 1
0 8 8
0 1.5 1.5
0 0 8
0 0 0.5
0 8 3.5
0 1.5 0
( 5) ( 6)
Sat
HOURLY
12/8 TOTAL RATE
HOURS OF PAY
0 16 $18.62
0 4 $27.93
0 6 $75.23
0 5 $ 55.73
0 2 $72.85
0 6.5 $59.91
0 1.5 $ 55.73
0 2 $ 72.85
0 18 $55.73
0 7 $72.85
0 16 $55.73
0 5.5 $72.85
0 24 $55.73
0 6 $72.85
0 18 $75.23
0 6 $97.88
0 8 $75.23
0 0.5 $97.88
0 19.5 $55.73
0 3.5 $72.85
CONTRACTOR'S LICENSE #
SPECIAL TY LICENSE #
7J45679A18
( 7)
GROSS AMOUNT
EARNED
THIS ALL
PROJECT PROJECTS
FWH
$ 45.00
$ 409.64 $ 409.64 TRAINING
$ .
FWH
$ 162.00
$ 451.38 $ 1,833.70 TRAINING
$
FWH
$ 162.00
$ 424.35 $ 1,833.70 TRAINING
$ .
FWH
$ 445.00
$ 389.42 $ 2,644.71 TRAINING
$ .
FWH
$ 445.00
$ 229.30 $ 2,644.71 TRAINING
$ .
FWH
$ 160.00
$ 1,513.09 $ 1,847.47 TRAINING
$ .
FWH
$ 431.00
$ 1,292.36 $ 2,871.84 TRAINING
$ -
FWH
$ 193.00
$ 1,774.62 $ 1,774.62 TRAINING
$ -
FWH
$ 392.00
$ 1,941.42 $ 2,392.80 TRAINING
$ .
FWH
$ 375.00
$ 650.78 $ 2,230.75 TRAINING
$ -
FWH
s 370.00
$ 1,341.72 $ 2,121.72 TRAINING
$ .
FWH
TRAINING
653307 ADDRESS
PO Box 1919 San Luis Obis� CA 93406
PROJECT OR CONTRACT # Waterline Replace Spec 91436
PROJECT & LOCATION San Luis Ob isoo
( 8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
MCARE FICA STTAX SOI VAf'IHOL HEAl.TMIWELf PENSION
$ 6.92 $ 29.60 $ 12.22 $ $ . $ -$ -
FUNDAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAlDEO CHKNUM
$ -$ -$ $ .$ -$ 93.74 1844
MCARE FICA ST TAX SDI VAf'IHOL HEAL THIWELf PENSION
$ 26.59 $ 113.69 $ 127.23 $ $ . $ $ -
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ $ $ . $ $ 117.50 $ 547.01 002951
MCARE FICA ST TAX SDI VACIHOL HEALlHIWELf PENSION
$ 26.59 $ 113.69 $ 127.23 $ . $ -$ . $ -
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ . $ -$ . t 117.50 $ 547.01 002951
MCARE FICA ST TAX SDI VACIHOL HEAL """'ELF PENSION
$ 38.35 $ 163.97 $ 211.93 $ . $ . $ -t -
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ . $ $ . $ 180.00 $ 1 039.25 002954
MCARE FICA ST TAX SDI VACIHOL HEAL11ilWELf PENSION
$ 38.35 $ 163.97 $ 211.93 $ . $ . $ . $ .
FUND AOMlN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ . $ $ . $ 180.00 $ 1 039.25 002954
MCARE FICA ST TAX SOI VACIHOL HEAL™IWELf PENSION
$ 26.79 $ 114.54 $ 76.39 $ . $ $ . $ -
FUNOAOMIN DUES lRV/SUBS SAVINGS OniER TOTAL OED CHKNUM-
$ . $ -$ . $ -$ 155.00 $ 532.72 002956
MCARE FICA ST TAX SDI VAf'IHOL HEAL THIWELf PENSION
$ 41.64 $ 178.05 $ 225.34 $ . $ . $ $ -
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ -$ -$ $ . $ 227.50 $ 1103.53 002958
MCARE FICA ST TAX sor VAf'IHOL HEAL,.,,,""Elf PENSION
$ 25.73 $ 110.03 $ 110.05 $ . $ $ . $ .
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM-
$ -$ . $ -$ . $ 150.00 $ 588.81 1848
MCA RE FICA ST TAX SDI VAf'IHOL HEAL"'"""'• PENSION
$ 34.69 $ 148.36 $ 186.70 $ . $ -$ $ -
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ $ -$ . $ 150 .00 $ 911.75 1849
MCARE FICA ST TAX sor VAC/HOL HfAl.'T><IWELf PENSION
$ 32.34 $ 138.31 $ -$ . $ -$ . $ .
FUNDAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ -$ . $ -$ . $ 137.50 $ 683.15 1850
MCARE FICA ST TAX SDI VAnHOL HEAL,.,,,"''ELF PENSION
$ 30.77 $ 131.54 $ 79.26 $ . $ . $ $ .
FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ -� $ .s 342.89 $ 954.46 002959
MCARE FICA ST TAX SDI VAf'lHOL HEAL,.,,"""'" PENSION
FUNDAOMlN DUES 'TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
( 9)
NET
WAGES
PAID FOR
WEEK
$ 315.90
$1,286.69
$1,286.69
$1,605.46
$1,605.46
$1,314.75
$1,768.31
$1,185.81
$1,481.05
$1,547 .60
$1,167.26
D = Doubletime
* OTHER • Any other deductions, contributions and/or payments whether or not included or required by prevailing
wage determinat ions must be separately listed. Use extra sheet if necessary. CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www .CertifiedPayrollReports.com
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( 1 ) ( 2) NAME, ADDRESS AND Number of
SOOAL SECURilY NUMBER Withholding
OF EMPLOYEE Exemotlons
Anthony E Lopez Ramirez
2912 lopez Dr
Arroyo Grande, CA 93420
Bryce Crespin 4355 cayucos Ave
Atascadero, CA 93422 0
0
0
0
0
0
0
0
0
Bryce Crespin
4355 cayucos Ave
Atascadero, CA 93422
Clinton R Barry 776 Brahma St
Paso Robles, CA 93446 xxxx -George Llamas 800 E. Cook Santa Maria, CA 93454
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
Manuel Robledo 9694 Birmingham Ave Riverside, CA 92509 0
Philip C Brainard III 1501 14th St Los Osos, CA 93402 0
FORM A-1-131 (New 2-80)
diR Callfomia Departrnt,lt of Industrial Reiatlons PUBLIC WORKS PAYROLL REPORTING FORM
NAME OF CONTRACTOR D·KAL Engineering CONTRACTOR'S LICENSE # 653307 ADDRESS
OR SUBCONTRACTOR SPECIALlY LICENSE#
PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE# PROJECT OR CONTRACT#
13 1?11512018 WORKERS' COMPENSATION POLICY# 7J45679A18 PROJECT & LOCATION
PAGE
PO Box 1919 San Luis Obisnn CA 93406 Waterline Replace Spec 91436 San Luis Obisoo
(4) DAY ( 5) ( 6) ( 7) ( 8) ( 9)
( 3) Sun Mon Tue Wed Thu Fri Sat GROSS AMOUNT NET
DATE HOURLY EARNED WAGES
WORK 12/9 12/10 Pill 12/12 12/13 12/14 12/15 TOTAL RATE THIS ALL DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PAID FOR
CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY PROJECT PROJECTS
Apprentice s 0 8
Laborer D
0 0 1.5
s 0 7
carpenters D
0
s 0 0
Laborer D
0 0 0
s 0 8
Equip. Opers. D
0 0 2.5
s 0 8
Teamsters D
0 0 1.5
s 0 8
Laborer D
0 0 2
s 0 8
Laborer D
0 0 1.5
�W.AIJ s
D 0 8
0
Laborer
Laborer
Laborer
carpenters
s 0 8
D
0 0 1.5
s 0 8
D
0 0 2.5
s 0 8
D
0 0 2.5
s 0 6
D
0
S = Straight time
O = Overtime
D =Doubletime
8
2.5
0
8
2
8
1.5
8
4.5
8
2
8
2
8
8
0
8
2
8
2.5
0
FWH MCARE FICA ST TAX
7 0 0 0 23 $18.62 ,t: 79.00 $ 12.39 $ 52.98 $ 22.75
$ 730.84 $ 730.84 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 4 $27.93 $ $ $ -$ FWH MCARE FICA ST TAX
0 0 0 0 7 $62.02 $ 343.00 $ 40.53 $ 173.30 $ 224.22
$ 434.14 $ 2,795.10 TRAINING FUNDAOMIN DUES TRV/SUBS
$ $ -$ -$
FWH MCARE FICA ST TAX
0 0 0 0 8 $55.73 s 343.00 $ 40.53 $ 173.30 $ 224.22
$ 591.54 $ 2,795.10 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 2 $72.85 $ $ -$ $ FWH MCA RE FICA ST TAX
8 8 8 0 40 $75.23 $ 455.00 $ 51.44 $ 219.95 $ 301.22
$ 3,547.54 $ 3,547.54 TRAINING FUNDAOMIN DUES TRV/SUBS
1 0.5 0 0 5.5 $97.88 $ -$ -$ $ -
FWH MCA RE FICA ST TAX
0 0 0 0 16 $59.91 $ 876.00 $ 60.89 $ 260.34 $ 383.40
$ 1,410.66 $ 4,198.99 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 6 $ 75.35 $ -$ -$ -$ -
FWH MCARE FICA ST TAX
0 0 8 0 24 $ 55.73 $ 439.00 $ 47.43 $ 202.81 $ 241.11
$ 1,628.92 $ 3,271.08 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 4 $ 72.85 ,t: -$ $ -$ -
FWH MCARE FICA ST TAX
0 0 0 0 16 $55.73 t 406.00 $ 44.88 $ 191.92 $ 200.74
$ 1,146.66 $ 3,095.54 TRAINING FUNOAOMIN DUES TRV/SUBS
0 0 0 0 3.5 $ 72.85 t -$ -$ -$ -
--(lfj) ,il.iD .ll FWH MCARE FICA ST TAX
t 437.00 $ 44.95 $ 192.20 $ 271.24
0 0 8 0 24 � $� $ 3,100.00 TRAINING FUNDAOMIN DUES TRVISUBS
t -$ -$ -$ -
FWH MCARE FICA ST TAX
0 0 0 0 16 $55.73 $ 269.00 $ 44.19 $ 188.96 $ 168.37
$ 1,000.96 $ 3,047.68 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 1.5 $72.85 $ -$ -$ -$ -
FWH MCARE FICA ST TAX
8 8 8 0 40 $55.73 $ 487.00 $ 45.26 $ 193.51 $ 251.54
$ 2,884.85 $ 3,121.10 TRAINING FUNDAOMIN DUES TRV/SUBS
3 1 0.5 0 9 $ 72.85 $ -$ -$ -$ -
FWH MCARE FICA ST TAX
8 8 8 0 40 $62.02 $ 295.00 $ 41.09 $ 175.70 $ 155.55
$ 3,136.40 $ 3,136.40 TRAINING FUND AOMIN DUES TRV/SUBS
2 1 0 0 8 $81.95 t -$ -$ -$ -
FWH MCARE FICA ST TAX
0 0 0 0 6 $62.02 t 378.00 $ 38.40 $ 164.19 $ 200.49
$ 372.12 $ 2,648.32 TRAINING FUNDADMIN DUES TRV/SUBS
$ -$ -$ $
• OTHER -Any other deductions, aintributions and/or payments whether or not included or required by prevailing wage determin ations must be separate ly listed. Use extra sheet if necessary.
WEEK
SDI VA<'JHOL HEAL TM/Waf PENSION
$ -$ -$ $ -
SAVINGS OTHER TOTAi.OED OtKNUM $ 563.72
$ -$ -$ 167.12 1858
SDI VArJHOL HEAL TM/Waf PENSION
$ -$ -$ $
SAVINGS OTHER TOTAL OED OtKNUM $1,789.05
$ -$ 225.00 $ 1 006.05 002960
SDI VAC/HOL HEALTMIWELf PENSION
$ -$ $ -$ -
SAVINGS OTHER TOTAi.OED OtKNUM $1,789.05
$ -$ 225.00 $ 1 006.05 002960
SDI VAC/HOL HEAl.=""ELF PENSION
$ -$ $ $ -
SAVINGS OTHER TOTAI.OEO OtKNUM $ 2,292.43
$ -$ 227.50 $ 1 255.11 002961
SDI VAC/HOL Hm=••�Lf PENSION
$ $ $ $ -
SAVINGS OTHER TOTAL OED OtKNUM $ 2,408.36
$ -$ 210.00 $ 1 790.63 002964
SDI IIA<'IHOL HEAt.TMIWl'I c PENSION
$ -$ -$ $ -
SAVINGS OTHER TOTAL OED OtKNUM $ 2,050.87
$ -$ 289.86 $ 1 220.21 002965
SDI VAGHOL HEAl.TH/WELf PENSION
$ -$ -$ $ -
SAVINGS OTHER TOTAi.OED OtKNUM $ 2,014.50
$ -$ 237.50 $ 1 081.04 002966
SDI VA<'JHOL HEALTMIWEL • PENSION
$ -$ -$ -t
SAVINGS OTHER TOTAI.DEO OtKNUM $ 2,054.61
$ -$ 100.00 $ 1 045.39 002967
SOI VArlHOL HEALTUIWB.f PENSION
$ -$ -$ -$
SAVINGS OTHER TOTAi.OED OtKNUM $ 2,122.16
$ -$ 255.00 $ 925.52 1853
SDI VA<'IHOL Hl:Al.=n""'c PENSION
$ -$ $ -$ -
SAVINGS OTHER TOTAi.OED OtKNUM $1,898.79
$ -$ 245.00 $ 1 222.31 002968
SDI VA<'IHOL HEAi.'"""""' • PENSION
$ -$ $ -$ -
SAVINGS OTHER TOTAi.OED OtKNUM $ 1,926.61
$ -$ 542.45 $ 1 209.79 1854
SDI VAGHOL HEAt.'""""BF PENSION
$ -$ t t -
SAVINGS OTHER TOTAL OED OtKNUM $ 1,642.24
$ -t 225.00 $ 1 006.08 1855
CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com
( 1) ( 2)
NAME, ADDRESS AND Numberd
SOCIAL SECURllY NUMBER Withholding
OF EMPLOYEE Exemot:lons
Philip C Bra inard Ill
1501 14th St
Los Osos, CA 93402 0
Ronnie Ramsey
PO Box 141
Cayuc:os, CA 93430-0410 0
Timothy D Ambrosi
1199 W Hwy 246 #C
Buellton, CA 93427 0
FORM A·l-131 (New 2-80)
diR California Department ot lnduStrlal R<latlons PUBLIC WORKS PAYROLL REPORTING FORM
NAME OF CONTRACTOR D-KAL Engineering CONTRACTOR'S LICENSE # 653307 ADDRESS
OR SUBCONTRACTOR SPECIALTY LICENSE #
PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE# PROJECT OR CONTRACT #
13 12/15/2018 WORKERS' COMPENSATION POLICY# 7J45679A18 PROJECT & LOCATION
PAGE 2
PO Box 1919 San Luis Obisnn. CA 93406
Waterline Replace Spec 91436
San Luis Obisnn
141 DAY ( 5) ( 6)( 7) ( 8) ( 9)
( 3) Sun I Mon Tue I Wed I Thu I Fri I Sat GROSS AMOUNT NET
DATE HOURLY EARNED WAGES
WORK 12/9 112/10 12/11 12/12 12/13 12114 12/15 TOTAL RATE nus ALL DEDUCTIONS, CONTRJBUTIONS AND PAYMENTS PAID FOR
CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY PROJECT PROJECTS
Laborer
Equip. Opers.
Equip. Opers.
s 0 2
D
0 0 1.5
s 0 8
D
0 0 1
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
0 = Overtime
D = Doubletime
8
2
8
1.5
8
0.5
FWH MCARE FICA ST TAX
8 0 0 0 18 t55.73 t 378.00 $ 38.40 $ 164.19 $ 200.49
$ 1,403.82 $ 2,648.32 TRAINING FUNOAOMIN DUES TRVISUBS
2 0 0 0 5.5 t 72.85 $ . $ . $ $ FWH MCARE FICA STTAX
0 0 0 0 16 $ 75.23 t 306.00 $ 29.19 $ 124.78 $ 146.06
$ 1,448.38 $ 2,012.61 TRAINING FUNOAOMIN DUES TRVISUBS
0 0 0 0 2.5 $97.88 t -$ . $ -$
FWH MCA RE FICA ST TAX
0 0 0 0 8 $ 75.23 t 333.00 $ 29.80 $ 127.41 $ -
$ 650.78 $ 2,386.59 TRAINING FUNDAOMIN DUES TRV/SUBS
0 0 0 0 0.5 $97.88 $ -$ . $ $ -
FWH MCARE FICA ST TAX
TRAINING FUNDAOMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNDAOMIN DUES TRVISUBS
FWH MCARE FICA ST TAX
TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FIJNDAOMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNDADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNOADMIN DUES TRV/SUBS
FWH MCARE FICA ST TAX
TRAINING FUNOAOMIN DUES TRV/SUBS
*OTHER -Any other deductions, contributions and/or payments whether or not inc luded or required by prevailing
wage determinations must be separate ly listed. Use extra sheet if necessary.
WEEK
SDI VAC/HOL HEAL TH/WELF PENSION
$ -$ $ $ -
SAVINGS OTHER TOTAL OED Ofl<NUM $1,642.24
$ -$ 225.00 $ 1 006.08 1855
SDI VAC/HOL HEAL TH/WEI• PENSION
$ -$ $ . $ .
SAVINGS OTHER TOTAL OED CHKNUM $1,276.58
$ -$ 130.00 $ 736.03 1856
SDI VACJHOL HEAL Tii/WELF PENSION
$ $ -$ -$ -
SAVINGS OTHER TOTAL OED CHKNUM $1,424.86
$ $ 471.52 $ 961.73 1857
SDI VACJHOL HEAL TMIWELF PENSION
SAVINGS OTHER TOTAL OED CHKNUM
SDI VAC:/HOL HEAL TMIWEl.F PENSION
SAVINGS OTHER TOTAL OED CHKNUM
SDI VAC/HOL HEAL TH/WEl.F PENSION
SAVINGS OTHER TOTAL OED 01KNUM
SDI VAC/HOL HEALTH/WELF PENSION
SAVINGS OTHER TOTALDED 01KNUM
SDI VAC/HOL HEALTH/WEl.F PENSION
SAVINGS OTHER TOTAL OED CHKNUM
SOI VAC/HOL HEAL TH/WELF PENSION
SAVINGS OTHER TOTAL OED CHKNUM
SDI VAC/HOL HEAl"'IW<1 • PENSION
SAVINGS OTHER TOTALDED OIKNUM
sor VAC/HOL HEAL"'"""'°' PENSION
SAVINGS OTHER TOTAL OED OIKNUM
SDI VAC/HOL HEALTMIWl'IF PENSION
SAVINGS OTHER TOTAL OED Ofl< NUM
CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www. Certified Payroll Reports.com
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( 1 ) ( 2) NAME, ADDRESS AND Numbe< of
SOOAL SECURITY NUMBER Wl1hholdlng
OF EMPLOYEE ·--
Anthony E Lopez Ramirez 2912 lopez Dr Arroyo Grande, CA 93420 0
Bryce Crespin 4355 Cayucos Ave Atascadero, CA 93422 0
Bryce Crespin
4355 Cayucos Ave
Atascadero, CA 93422 0
0
Clinton R Barry
776 Brahma St
Paso Robles, CA 93446
George Llamas
800 E. Cook
Santa Maria, CA 93454 0
0
Iran A Nieves 1628 Village Ct Santa Maria, CA 93454
Jacob D Rexford 2761 Chaparral Lane Paso Robles, CA 93446 0
Jacob D Rexford 2761 Chaparral Lane Paso Robles, CA 93446 0
0
0
0
0
James Douglas 612 Laura Way Paso Robles, CA 93446 xxx-xxxJames Yanez 538 County Lane San Luis Obispo, CA 93401 xxx-xx-xxxx Jose Sanchez Garcia 558 Ferro Lane Paso Robles, CA 93446 xxx-xx· xxxxJuan Manuel Barrios 1021 Gaylene Dr Santa Maria, CA 93458
FORM A-1-131 (New 2·80)
diR Callfomla Department or 1n0ust11a1 RelatJons PUBLIC WORKS PAYROLL REPORTING FORM PAGE
NAME OF CONTRACTOR D-KAL Engineering OR SUBCONTRACTOR PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE # 14 12122/2018 WORKERS' COMPENSATION POUCY # 4\ DAY
( 3) Sun Mon Tue Wed I Thu I Fri Sat
DATE WORK 12/16 12/17117/18112/19 1)120 12/21 12122
CLASSIFICATION HOURS WORKED EACH DAY
Apprentice s 0 0
Laborer D
0 0 0
s 0 0
Equip. Opers. D
0
s 0 0
Laborer D
0 0 0
s 0 0
Equip. Opers. D
0 0 0
s 0 0 Teamsters D
0 0 0
Apprentice s 0 0
Laborer D
0 0 0
s 0 0
Equip. Opers. D
0
s 0 0
laborer D
0 0 0
s 0 0
laborer D
0 0 0
� s '. D 0 0 ,�,. 'vuia-11< rt) 0
laborer
Laborer
s 0 0
D
0 0 0
s 0 0
D
0 0 0
S = Straight time O = Overtime
0 8 0 0
0 1.5 0 0
0 7 0 0
0 1 8 0
0 2 0 0
8 8 8 8
2 1 0 1
8 8 8 8
2 1.5 0.5 1
0 8 8 4.5
0 1.5 0.5 0
0 0 0 3.5
8 8 0 4.5
0 0 0.5 0
8 8 8 8
2 2 0.5 2.5
10 10 8.5 10
0 8 8 8
0 0.5 0 2
8 8 8 0
2 1 0.5 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(5) ( 6)
HOURLY TOTAL RATE HOURS OF PAY
8 $18.62
1.5 $ 27.93
7 $75.23
9 S 55.73
2 $ 72.85
32 $75.23
4 $97.88
32 $59.91
5 $75.35
20.5 $18.62
2 $ 27.93
3.5 $ 75.23
20.5 $55.73
0.5 $87.57
32 $58.38
7 $ 77.35 77::Z 38.5 �
24 $55.73
2.5 $72.85
24 $ 55.73
3.5 $72.85
CONTRACTOR'S UCENSE # 653307 ADDRESS SPEOAL TY UCENSE # PO Box 1919 San Luis Ob is= CA 93406
PROJECT OR CONTRACT # Waterline Replace Spec 91436 7J45679Al8 PROJECT & LOCATION San Luis Obisoo
( 7) ( 8) GROSS AMOUNT EARNED
THIS ALL DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS PROJECT PROJECTS FWH MCARE FICA ST TAX SDI VAl'lHOL HEAL"Tli/WR F PENSION
$ -$ $ -$ -$ -$ $ -$ -
$ -$ -TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OtliER TOTAL OED OtKNUM
$ -$ $ -$ -$ -$ $ -
FWH MCARE FICA ST TAX SDI VANHOL HEALTHJWElf PENSION
S 367.00 $ 42.20 $ 180.44 S 236.64 $ $ $ -$ -
$ 526.61 $ 2,910.44 TRAINING FUNDADM!N DUES TRVISUBS SAVINGS OtliER TOTAL OED CHKNUM
$ -$ $ -$ -$ S 230.00 $ 1 056.28 DD2970
FWH MCARE FICA ST TAX SDI vAriHOL HEAL TMJWELf PENSION
S 367.00 $ 42.20 $ 180.44 $ 236.64 $ -"'$ -$ -
$ 647.27 $ 2,910.44 TRAINING fUNDADMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED OfKNUM
$ -$ $ -$ -$ 'i 230.00 S 1 056.28 DD2970
FWH MCARE FICA ST TAX SDI vAriHOL HEAL TH/WELF PENSION
S 349.00 $ 43.77 $ 187.17 $ 246.70 $ $ $ -$
$ 2,798.88 $ 3,018.88 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OtliER TOTAL OED CHKNUM
$ $ -$ $ -$ 4; 180.00 $ 1 006.64 DD2971
FWH MCARE FICA ST TAX SOI VAriHOL HEALTHIWELF PENSION S 394.00 $ 35.29 $ 150.90 S 187.73 $ -i $ -$ -
$ 2,293.87 $ 2,433.87 TRAINING FUNDADMIN DUES TRV/SUBS SAVINGS OtliER TOTAL OED CHKNUM
$ -$ -$ . $ -$ S 185.00 $ 952.92 002974
FWH MCARE FICA ST TAX SDI VArfHOL HEALni/WELF PENSION
$ 31.00 $ 6.34 $ 27.13 $ 8.06 $ . $ $ $ -
$ 437.57 $ 437.57 TRAINING fUNOAOMIN DUES TRY/SUBS SAVINGS OTHER TOTALDEO CHKNUM
4: -$ -$ -$ . $ -$ -$ 72.53 1859
FWH MCARE FICA ST TAX SDI VAr'iHOL HEAL TH/WELF PENSION t 283.00 $ 36.20 s 154.78 $ 168.53 $ $ $ . $ -
$ 263.31 $ 2,496.56 TRAINING FUNDADM!N DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM '1 -$ -$ -$ -$ $ 224.86 $ 867.37 002975
FWH MCARE FICA ST TAX SDI vAi'JHOL HEAL THIWELF PENSION
t 283.00 $ 36.20 $ 154.78 S 168.53 $ $ $ $ .
$ 2,163.25 $ 2,496.56 TRAINING FUNDADM!N DUES TRV/SUBS SAVINGS OTHER TOTALDED CHKNUM
4: -$ $ -$ -$ S 224.86 $ 867.37 002975
FWH MCARE FICA ST TAX SDI VANHOL HEALTHIWELF PENSION
S 265.00 $ 34.94 $ 149.40 S 128.07 $ $ -$ -$ -
$ 2,409.61 $ 2,409.61 TRAINING FUNDADM!N DUES TRV/SUBS SAVINGS OTHER TOTALDED CHKNUM
$ -$ $ $ -$ S 195.00 $ 772.41 002976
)<f�-7�� FWH MCARE FICA ST TAX SDI VAriHOL HEAL THIWELF PENSION
$ 437.00 $ 44.95 $ 192.20 S 271.24 $ -$ $ -$ -
$� $ 3,100.00 TRAINING fUNDADM!N DUES TRV/SUBS SAVINGS OTHER TOTALOEO OtKNUM
$ . $ . $ . $ -$ -S 100.00 $ 1 045.39 002977
FWH MCARE FICA ST TAX SDI VAriHOL HEAl.'""1WELf PENSION
$ 183.00 $ 38.20 S 163.32 t 124.24 $ -$ $ $ -
$ 1,519.65 $ 2,634.25 TRAINING FUNDADM!N DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ -$ $ . $ $ . s 232.50 $ 741.26 1861 FWH MCARE FICA ST TAX SDI vAr/HOL HEALTHIW8F PENSION � 269.00 $ 31.06 $ 132.82 $ 148.77 $ $ $ -$ -
$ 1,592.50 $ 2,142.23 TRAINING FUNDADMIN DUES TRVISUBS SAVINGS OTHER TOTALDED CHKNUM � -$ -$ $ -$ 4: 175.00 $ 756.65 002978
( 9) NET WAGES
PAID FOR WEEK
$
$1,854.16
$1,854.16
$ 2,012.24
$1,480.95
$ 365.04
$1,629.19
$1,629.19
$1,637.20
$ 2,054.61
$1,892.99
$1,385.58
D = Doubletime
*OTHER -Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. Use extra sheet if necessary. 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 Withholding
OF EMPLOYEE Exem""'""'
Luis Abarca
13737 Geronimo Rd
SANTA MARGARITA, CA 9345
Manuel Robledo
9694 Birmingham Ave
Riverside, CA 92509
Philip C Brainard III
1501 14th St 0
0
Los Osos, CA 93402
Ronnie Ramsey
PO Box 141
Cayucos, CA 93430-0410
FORM A-1-131 (New 2·80)
diR California Department
of Industrial Relations PUBLIC WORKS PAYROLL REPORTING FORM PAGE
NAME OF CONTRACTOR 0-KAL Engineering
OR SUBCONTRACTOR
PAYROLL NUMBER FOR WEEK ENDING SELF-INSURED CERTIFICATE #
14 1Jl2Jl2018 WORKERS' COMPENSATION POLICY#
(4) DAY
( 3) Sun Mon Tue Wed Thu Fri Sat
DATE
WORK 12i16 12117 17118 12/19 12/20 12/21 12/22
CLASSIFICATION HOURS WORKED EACH DAY
Apprentice
Laborer
Laborer
Laborer
Equip. Opers.
s 0 0
D
0 0 0
s 0 2
D
0 0 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 = Straight time
0 = Overtime
0 0 8 8 0
0 0 0 2 0
0 0 8 8 0
0 0 0.5 1.5 0
0 0 0 4 0
0 0 0 1.5 0
8 8 8 8 0
2.5 0 0 2 0
( 5) ( 6)
HOURLY
TOTAL RATE
HOURS OF PAY
16 $20.48
2 $30.72
18 $62.02
2 $81.95
4 S 55.73
1.5 $72.85
32 $75.23
4.5 $97.88
CONTRACTOR'S LICENSE # 653307 ADDRES S
SPECIAL1Y LICENSE# PO Box 1919 San Luis Obisnn CA 93406
PROJECT OR CONTRACT # Waterline Replace Spec 91436
7J45679A18 PROJECT & LOCATION San Luis Obis""
(7) (8)
GROSS AMOUNT
EARNED
THIS ALL DEDUCTIONS, CONT RIBUTIONS ANO PAYMENTS
PROJECT PROJECTS
FWH MCARE FICA ST TAX SDI VAC/HOL HEALTU"'"'LF PENSION � 42.00 $ 6.53 $ 27.91 $ 10.87 $ . $ . $ . <t .
$ 389.12 $ 389.12 TRAINING FUNOAOMIN DUES TRY/SUBS SAVINGS OTHER TOTAlDEO CHKNUM
t . $ . $ . $ . $ $ . $ 87.31 1862
FWH MCARE FICA ST TAX SDI VAC/HOL HEAL TUlwElf PENSION
$ 34.00 $ 14.18 $ 60.62 $ 12.37 $ $ . $ . t .
$ 1,280.26 $ 1,280.26 TRAINING FUNDAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ . $ $ . $ $ 402.45 $ 523.62 1863
FWH MCARE FICA ST TAX SDI VA<'IHOL HEAL TU""EL.F PENSION
S 308.00 $ 33.91 $ 144.99 S 167.48 $ $ . $ . $
$ 332.20 $ 2,338.48 TRAINING FUNOAIJM!N DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
$ . $ . $ $ . $ S 207.50 $ 861.88 1864
FWH MCARE FICA ST TAX SOI VArlHOL HEAI.TWIWEL.F PENSION
S 494.00 $ 41.29 $ 176.56 $ 234.48 $ $ . $ $ .
$ 2,847.82 $ 2,847.82 TRAINING FUNDADMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
$ $ . $ . $ $ . S 182.50 S 1128.83 1865
FWH MCARE FICA ST TAX SDI VAC-IHOL HEAl.'TWIWR c PENSION
TRAINING FUNDAOMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SDI vA-,MoL HEALTUIWElf PENSION
TRAINING FUNOAOMIN DUES TRY/SUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SDI VAC/HOL HEAi.TU/WCi. PENSION
TRAINING FUNDAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SDI VAC/HOL HEAl.'THIWEl.F PENSION
TRAINING FUNDAOMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SOI VAC/HOL HEAI.T}lJWELF PENSION
TRAINING FUNOAOMIN DUES TRV/SUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SDI VAC-IHOL HEAL TU ""ELF PENSION
TRAINING FUNOADMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SOI VAC-lHOL HEAl.""""ELF PENSION
TRAINING FUNDAIJMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
FWH MCARE FICA ST TAX SOI VAC/HOL HEALTMIWELf PENSION
TRAINING FUNDAOMIN DUES TRVISUBS SAVINGS OTHER TOTAL OED CHKNUM
( 9)
NET
WAGES
PAID FOR
WEEK
$ 301.81
$ 756.64
$1,476.60
$1,718.99
D = Ooubletime
* OTHER • Any other deductions, contributions and/or payments whether or not included or required by prevailing
wage determinations must be separately listed. Use extra sheet if necessary. CERTIFICATION must be completed (see back)
Sunburst Software Solutions, Inc. -Certified Payroll Solution www.CertifiedPayrollReports.com
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