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Home My WebLink About20220831103307442 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. NAME OF CONTRACTOR_ OR SUBCONTRACTOR_ ADDRESS 769 Pinto Circle OMB NO.: White Rock Construction Inc. Gardnerville NV 89410 Expires: PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECTOR CONTRACT NO. Keller Heavenly 3 2 8/20/2022 12:00:00 AM 1275 Meadow Crest Drive South Lake Tahoe CA (1) (2) (3) ( (4)DAY AND DATE (5) (6) (7) (8)DEDUCTIONS (9) Sun Mon Tue Wed 'Thu Fri Sat ' GROSS NAME AND INDIVIDUAL IDENTIFYING N0.OF AMOUNT FEDERAL STATE NET NUMBER(e.g.,LAST FOUR DIGITS OF W/H OT 14 15 16 17 18 19 20 EARNED WITH WITH- WAGES SOCIAL SECURITY NUMBER)OF EXEMP WORK C. TOTAL 'RATE PROJECT HOLDING HOLDING TOTAL PAID WORKER TIONS 'CLASSIFICATION ST HOURS WORKED EACH DAY HOURS OF PAY /PERIOD FICA TAX TAX MEDICARE OTHER DEDUCTIONS FOR WEEK Dwight E Bolton 1 1000 0 _ 347.10 759 Homet Drive TE S 5.00 5.00 69.42 2,980.18 184.77 377.49 43.21 3.82 609.29 2,370.89 Gardnerville NV 89460 Steven Nieves Badillo 0 1000 0 1.00 0.50 0.50 2.00 80.17 2,099.07 _ BO:Rlo Grande HC 57 GLP S 7.00 8.00 8.00 8.00 31.00 62.54 2,663.00 165.11 500.50 141.87 38.61 23.09 869.18 1,793.82 Box 9042 Aquada PR 00602 Richard R Nieves Sanchez 1 1000 0 1.00 0.50 0.50 2.00 80.17 _2,099.07 HC57 Box 9042 GLP S 7.00 8.00 8.00 8.00 31.00 62.54 2,663.00 165.11 460.80 139.14 38.61 23.09 826.75 1,836.25 Aquada PR 00602 Totals for Project Keller Heavenly 3 16.00 22.00 16.00 17.00 71.00 _4,54_5.24 8,306.18 514.99 1,338.79 281.01 120.43 50.00 2,305.22 6,000.96 While completion of Form W H-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a).The Copeland Act(40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week."U.S.Department of Labor(DOL) regulations at 29 C.F.R.§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.If you have any comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W.Washington, D.C.20210 Date 8 20 2022 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I,Katie McCroskv(Name of Signatory Party)Secretary(Title) _Each laborer or mechanic listed in the above referenced payroll has been paid,as do hereby state: indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (1)That I pay or supervise the payment of the persons employed by except as noted in Section 4(c)below. White Rock Construction Inc.(Contractor or Subcontractor)on the (c)EXCEPTIONS Keller Heavenly 3(Building or Work);that during the payroll period commencing on EXCEPTION(CRAFT) EXPLANATION 8/14/2022 and ending 8/20/2022 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said White Rock Construction Inc. (Contractor or Subcontractor) 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 as defined in Regulations,Part 3(29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948,63 Stat. 108,72 Stat.967;76 Stat.357;40 U.S.C.§ 3145),and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above REMARKS: period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he 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 recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: NAME AND TITLE SIGNATURE (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS Katie McCrosky _ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in Secretary the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate rams for the benefit of such em ployees,to es except THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT ONTRACTO r0 programs p y � p SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OFT 18 AND SECTIONN 231 OF as noted In Section 4(c)below. TITLE 31 OF THE UNITED STATES CODE.