HomeMy WebLinkAbout20230325142858561_Redacted Date 8/17/2022 (b)WHERE FRINGE BENEFITSARE PAID IN CASH
I, Martha Lopezministrative Assistant Each laborer or mechanic listed in the above referenced payroll has
I been paid, as indicated on the payroll, an amount not less than the
(Name of Signamry Parry) (ntle) sum of the applicable basic hourly wage rate plus the amount of the
required fringe benefits as listed in the contract, except as noted in
certify under penalty of perjury: Section 4(c)below.
(1) That I pay or supervise the payment of the persons employed by
PENHALL COMPANY on the (c)EXCEPTIONS
(Contractor orSubcontmoo)
SM WorkOrder.67681 (CP)WHITE ROCK CONSTRUCTION ;that during the payroll period commencing on the EXCEPTION(CRAFT) EXPLANATION
6 day of August 2022 and ending the 12 day of August 2022 Week#: 1
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
PENHALL COMPANY
(Contractor or SubcontractoO
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.
see attached pages for more deduction detail.
(2) That any payrolls otherwise under this contract required to be submitted for the above period are REMARKS:
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, of if no such recognized agency exists
in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of
Labor. NAMEANDTITLE SIGNATURE
(4)That: Martha Lopez
Administrative Assistant i
(a) WHERE FR NGE BENEFITS ARE PAID TO APPROVED THE vnuFUL FALSTFICA71ON OF ANY OF THE ABOVE STATEIMENTS MAY SUBJECT THE CONTRACTO�
PLANS,FUN OR PROGRAMS SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTIO 231
OF TITLE 31 OF THE UNITED STATES CODE.
In addition to the basic hourly wage rates paid to each laborer or mechanic
listed in the above referenced payroll, payments of fringe benefits as listed in
the contract have been or will be made to appropriate programs for the benefit
of such employees,except as noted in Section 4(c)below.