HomeMy WebLinkAbout20230522144529656 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 PROJECT OR CONTRACT NO.
Keller Heavenly 3
40 5/13/2023 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 INDNIDUAL IDENTIFYING NO.OF 7 8 9 10 11 12 13 AMOUNT FEDERAL STATE NET
NUMBER(e.g.,LAST FOUR DIGITS'OF W/H OT EARNED WITH- WITH- WAGES
SOCIAL SECURITY NUMBER)OF EXEMP WORK OR TOTAL RATE PROJECT HOLDING HOLDING TOTAL PAID
WORKER TONS CLASSIFICATION ST HOURS WORKED EACH DAY HOURS OF PAY /PERIOD FICA TAX TAX MEDICARE OTHER DEDUCTIONS FOR WEEK
EduardoAAcevedo 1 1000 0 0.50 0.50 79.801 1,410.28
PO Box 425 GI-3 S 8.00 2.00 4.00 8.00 22.00 62.29 1,916.53 118.82 272.80 56.48 27.79 12.69 488.58 1,427.95
Rincon PR 00677
Dwight E Bolton 1 1000 0 _ 172.52
759 Homet Drive L0928 S 2.00 2.00 86.26 3,841.39 238.17 547.43 217.49 55.70 32.38 1,091.17 2,750.22
Gardnerville NV 89460
Dwight E Bolton 1 1000 0 277.68
T3 S 4.00 4.00 69.42
Dwight E Bolton 1 1000 0 2.25 0.50 2.50 3.50 8.75 89.24 3,147.44
T5 S 2.00 8.00 7.75 8.00 8.00 33.75 70.12
German Franco 1 1000 0 0.50 0.50 115.10 758.67
1080 Centerville Road EX3 S 8.00 8.00 87.64 1,860.54 115.35 368.30 5.44 26.98 8.51 524.58 1,335.96
Gardnerville NV 89460
German Franco 1 1000 0 186.87
GI-3 S 3.00 3.00 62.29
Leslie McCrosky 0 1000 0 0.50 0.50 2.00 3.00 117.32 _3,203.79
897 Sprinq Valley Road SO S 8.00 8.00 8.00 8.00 32.00 89.12 3,702.11 229.53 571.37 231.14 53.68 33.32 1,119.04 2,583.07
Gardnerville NV 89410
Leslie McCrosky 0 1000 0 498.32
GI-3 S 8.00 8.00 62.29
Steven Nieves Badillo 0 1000 0 0.50 0.50 79.80 __ 662.80
BO:Rio Grande HC 57 GL3 S 8.00 2.00 10.00 62.29 1,431.55 88.76 202.49 12.50 20.76 5.97 330.48 1,101.07
Box 9042
Aquada PR 00602
Totals for Proiect Keller Heavenly 3 44.25 24.00 21.75 18.50 27.50 1 136.00 10,318.37
12,752.121 1 790.631 1,962.39 523.05 184.91 92.87 3,553.85 9,198.27
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 perform ing 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 subm it 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