HomeMy WebLinkAbout20220923114410607 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 PROJECTAND LOCATION PROJECTOR CONTRACT NO.
Keller Heavenly 3
6 9/17/2022 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 NO,OF 11 12 13 14 15 16 17 AMOUNT FEDERAL STATE NET
NUMBER(e.g.,LASTFOUR DIGITS OF W/H OT EARNED WITH- WITH- WAGES
SOCIAL SECURITY NUMBER)OF EXEMP WORK OR I I I I 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 2.75 3.50 1 6.25 88.20 _ 1,523.10
759 Homet Drive TE S 6.00 8.00 14.00 69.42 3,250.44 201.53 436.94 39.52 1 47.13 16.75 1 741.87 2,508.57
Gardnerville NV 89460
Totals for Pmiect Keller Heavenly 3 8.75 11.50 20.25 _1,523.10
3,250.44 201.53 436.94 39.52 47.13 16.75 741.87 2,508.57
While completion of Form WH-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 9 17 2022
(b)WHERE FRINGE BENEFITS ARE PAID IN CASH
I,Katie McCroskv(Name of Signatory Parry)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
9/11/2022 and ending 9/17/2022 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 ro rams for the benefit of such employees,exce t THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT CONTRACTOR N 2
programs P SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 TLE 18 AND SECTION 231 OF
as noted in Section 4(c)below. TITLE 31 OF THE UNITED STATES CODE.