Loading...
2017 GILMAN APPROVED PAYROLL PO Box 4817 2501 Belt View Drive REC�'VED PHONE: 406.449 8627 Helena, MT 59604 Great\'Vest �UL 261017 FAX: 406.449.8631 JEFF nrovov.greatwestenq.com engineering ® ERSON COVNTy ON LETTER OF TRANSMITTAL To: Helen Auch Date: July 24, 2017 Of: Jefferson County Project: Jefferson County-Kountz Bridge Address: 201 Centennial St Project No.: 1-15272 TO 4 Boulder, MT 59632 Subject: Certified Payrolls Phone: Fax: We transmit: ❑ As requested i1 Attached ❑ Under separate cover Via: ® Mail ❑ e-Mail ❑ Courier ❑ Overnight delivery ❑ Fax #of Copies Description 1 Jim Gilman Excavating approved Certified Payroll Our action: ❑ Reviewed ❑ Not approved ® Approved ❑ See remarks Action requested: ❑ Review and comment ❑ Approve/Accept ❑ Make corrections noted ❑ Revise and resubmit Z Place in project labor file Remarks: Helen, Please give me a call if you have any questions. Thank you, From: Elisa Prescott e-mail address: eprescott@greatwesteng.com Phone: 495-6152 cc: Grant File-LOT If enclosures are not as noted,please notify the sender immediately. ENGINEER'S PAYROLL CHECK SHEET TO: Jefferson County CONTRACT: Kountz Bridge Replacement 201 Centennial St Boulder, MT 59632 PROJECT NUM: 1-15272 TO 4 CONTRACTOR: Jim Gilman Excavating PAYROLL #: 1 PAYROLL PERIODS: FROM: 5/8/2017 TO: 5/14/2017 ZONE: - Payroll Review YES NO 1. Does payroll indicate project number and payroll period covered? Z ❑ 2. Are full names listed? (Do not include social security number or address) ® ❑ 3. Are workers properly classified and codes indicated that correspond to the ® ❑ contract? 4. Are the wage rate, overtime rates and gross pay correct? ® ❑ 5. Is overtime paid at the correct rate? ® ❑ 6. Are the deductions shown allowable and/or authorized? /1 ❑ 7. Have apprenticeship papers been provided, if needed? NA ❑ ❑ 8. Is Statement of Compliance attached to payroll? ® ❑ 9. Are benefits certified as "bona fide" and plan listed under remarks? ® ❑ 10. Has supplemental payroll been requested for this payroll? ® ❑ Additional Comments: Payroll Approved i1 ' 1 r Fn1-1527Nefferson County On-Call 2015\TO 4-Kountz Rd Bridge\Project\Construction Management\Labor Requirements\Payroll Review Form Payroll #1.docx STATEMENT OF COMPLIANCE o 7 L4 1I Date ✓I e May 22.2017 ) �l LaRae South Payroll Secretary do hereby state: I I I/ (Name ofSigalor)Pang) (Tae) p) That I pay or supervise the payment ofihe persons employed by Jim Gil Excavating.Inc .on /, (Contractor or5ubcoevaclor) the Kountz Road Bridges placement that during the payroll period cefnmencing on the 51h day of May and ending the 141 flay of May - all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or r611 be made either directly or indirectly to or on behalf of said Contractor from the full weekly wages earned by any person and that no deductions have (Contactor or Subcontractor) 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.276c)and described below: FICA Withheld Federal Withholding Tax Withheld Montana Withholding Tax Withheld • V Vacation Allowance Withheld 401(k)Deferrals (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the applicable wage rates contained in any wage determination incorporated into this 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: (a) WHERE GE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS ,-� - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,payments 4. or 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. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each Laborer or mechanic listed in the above referenced payroll has been paid as 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,except as noted in section 4(c)below. (c) EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION MARKS PAID TO Operator Fringes-H&W$6.35,Pension $2.00,Vacation$1.00 Montana OE-C.1.Trust Fund Appren$20,MLMA(Deduct)$.07. PO Box 31278 Billings,MT.59107-1278 fl'eamster Fringe-H&W$7.00,MLMA(Deduct)$.07 Montana Teamsters Contractors/Employers Trust PO Box 515196 Los Angeles,CA.90051-5196 roster Fringe-Pension$1.96 Western Conference of Teamsters Pension Trust PO Box 30480 Seattle,WA.98124-1080 i .borer Fringes-H&W 5.65,Pension$2.00,Vacation$1.00 Laborers-A.G.C.Trust of Montana Appren$.25,MLMA(Deduct) $.07 PO Box 31278 Billings,MT.59107-1278 *Indicates Individual is Mobilizing Equipment Wage Rates Not Contingent o Project Wages. SHIFTING Operators $1.35 Shifted From Fringes To Wages Teamsters $0.20 Shifted From Fringes To Wages . / Laborers $0.15 Shifted From Fringes To Wages -- Payroll#1 Effective 4/5/99-O p Operators&Laborers Vacation$1.00/hr. LaRae South / / SIGNATURE t/ r LaRae South-Treasurer THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 OF MIX II AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE • J ^ 7 .- cf)aiiiiiist1 / ok,r, Pit ( ' ° A 7 ® ® l ® �®y '� A ® 875 Fringe and Deduction Breakdown 2016 State Highway Rates Effective January 2, 2016 Operator Union Fringe Vacation 1.00 Deducted from hourly wage after taxes H &W 6.35 MLMA .07 Deducted from hourly wage after taxes Pension 2.00 Appren. .20 8.55 SH Fringe 9.90 1.35 Shifted from fringe to wage Teamster Union Fringe MLMA .07 Deducted from hourly wage after taxes H &W 7.00 Pension 1.96 8.96 SH Fringe 9.16 0.20 Shifted from fringe to g wage Laborer Union Fringe Vacation 1.00 Deducted from hourly wage after taxes H &W 5.65 MLMA .07 Deducted from hourly wage after taxes Pension 2.00 Appren. .25 7.90 SH Fringe 8.05 0.15 Shifted from fringe to wage Calculation: SH Wage +/- Shifted amount - Vacation if applicable = Hourly Wage shown on payroll. MLMA is deducted out of total net wages. Example: Operator Group 3 26.91 + 1.35(9.90 SH Fringe —8.55 Union Fringe) = 28.26 - 1.00 Union Vacation = 27.26 Hourly Wage. MLMA is then deducted from the employees'total net wages. An Equal Opportunity Employer 3099 GRAND AVE. • BUTTE, MONTANA 59701 • (406) 723-6349 OR 723-8234 • FAX (406)723-6778 01 000 Jim Gilman Excavating, Inc. DATE 5/19/17 PRP314 3099 Grand Ave. TIME 12:55 PAGE 6 _.. / 406-723-8234 FED I0* 81-0300860 -PAGE-- 1 OF-._._PAYROLL ,J- CERTIFIED-PAYRO1J_REPORT _-. HEW MING, - 05/14/2017 Job 875 KOINTZ R IDLE TANIETTI COS WAGE DECISION NO. 2014 DB -.- PO..BOX-6547- _- -__ CONTRACT-NUMBER-RRG=14=1561 GREAT FALLS MT 594066547 CONTRACT START 09/26/2016 li - THIS Job -- ----- THIS WEEK '.. --- HOURS WORKED THIS Job -- - TX TWL C9( DATE FICA SDI TOT PAY WORK --5-_.. .. 5/ _.5/----5/--51--5Y -5/--57--.-___ .. . NIX TVL ---BENEFITS-"-FEGU/T-.. UNION -.TOT Dm" ADDRESS CLASS- E MIN 08 09 10 11 12 13 14 TOT TY PAY TX ADJ SCK PAY ST W/T OTHER NET PAY ZIP CODE/ SOCIAL SECO/ EXM IFICATION X CDE MON TIE WED Till FRI BAT SUN HOUR HR RATE NTX ADJ TOT PAY LOC W/T SUT W/T CHECK WENDY L BOULTFR OPER 3 - DF 0 5.50 .00 .00 .00 .00 .00 .00 5.50 ST 29.7601 .00 051917 59.06 .00 1002.91 -.-.... .00 .00 52.53 72.92 259.78 429.97 .00----_.__. - __ _.. -. --__-. X00 _-__-__-700--- 38.21 ---__.00 572:94__ >00(-XX-5822 00 .00 .00 216.21 .00 .00 78329 - ,._-UM 001--_.01 H 6 W OPERATOR .._._34:93 --_.-. (148 001.__02-PENSION-OPERATR____.-11.00-_-UNB-_001_. 03 VACATION OPERTR --_.5[50 UNB 001 04 APPRENT OPERA 1.10 Ulm 001 01 H & W OPERATOR 171.47 IAD 001 02 PENSION OPERATR 54.00 Ulm 001 03 VACATION R 27.00 UM 001 04 APPRENT OPERATR 5.40 UM 001 05 OPERTOR NW FUND 1.91 WILLIAM CARELLI TRKDRIVER M.O 4.50 .00 .00 .00 .00 .00 .00 4.50 ST 30.390 .00 051917 13.79 .00 234.04 / .00 .00 4032 1.39 54.19 73.80 5CS° .00- --_.. ____-_ _. -_-. "_._..__ _--- .00 _:00 ____.4:43 ---.00 160.24 )0(X-U-9186 00 .00 .00 177.08 .00 .00 78330 -._. UNB-007--01-H ra TEAMSTERS . ..31:50--_ ___...-UNB-007-_02._.PENSION TCAMSTR -..- 8:82-_._ _UM-007._._01--11&W-TEAMSTERS _.42:00 UND 007 02 PENSION TEANSTR 11.7 UND 007 05 TENMSTR NW FUND 0.43 / ANTHONY-GARDIPEE (PER 3 - AKA' 5.50 ;00 -...:00 .00-._-X00.-..00_--.00--5:50""ST29:760TT 100__. 051917_--89•89 _... .•00- 1525.61 .00 .00 52.53 121.69 394.44 666.22 .00 .00 .00 60.20 .00 859.39 -_---XXX=XX=7796-01-_-- _---.00 .._____.___ -. _. _____-_. .00 ..._.-216:21__. 00 __..00 _.. 78335_-__-- - UM 001 01 H & W OPERATOR 34.93 UNB 001 02 PENSION OPERATR 11.00 UNB 001 03 VACATION OPERTR 5.50 L14B 001 04--APPFENT-OPERATR -_- -.1-.10_ _-Om__001--01--H-6-u-OPERATOR---260.36 _ .- .UND 001 02-PRSION"OPERATR-_. 82.00 Ulm 001 03 VACATION OPERTR 41.00 HOD 001 04 APPRENT OPERATR 8.20 UND 001 05 OERTOR NW FIND 2.88 2-). .00_-- 051917 ----115413 -'---00 --1970.96 __--- ,,-RONALD-J-HF3NORICKSON TRKORIVEft-_M-0_"--8.00 :00__...:00 .00 - :00--:00 01r--800-5T-30:390� _--_ TRKDRIVER 1.00 .00 .00 .00 .00 .00 .00 1.00 0U 45.59000 80064 263.78 469.60 928.50 -- 2-1, .00 .00 .00 79.99 .00 1042.46 _.- ---XXX-XX=9221-01-- -_.. _:00---- _.___---__ - __.. _. .00 -_-___369.36- _._ 00 _-_700 __78336._- + UNB 007 01 H 6 W TEAMSTERS 63400 Um 007 02 PENSION TEAMSTR 17.64 UM 002 01 H 6 W TEAMSTERS 42.00 ..UN0...002 -.02-PENSION-TEAMSTR-_--_-11.76 -___UND-002-05-TEAMGTR_NW_FUND- 0013_.._ UNIT 007 -01.H G-TEAMSTERS -_-.. 322.00 - U1ND 007 02 PENSION TEAMSTR 16 MD 007 05 TEAMSTR NU FUND 3.25 - .00' .00""6700-ST-30.390✓" .00-_.- 051917 _ --.90.39-__" -.00__...1562:47 - TIMOTHY J-HOGAR7 ---TRKORIVERsMO---6:00-__.00. _:00--:00-:00 ..___ -I 2-Y .00 .00 53.76 134.37 383.79 671.33 .00 .00 .00 62.78 .00 891.14 -10IX=XX=0751 00 ---._ __- _-700_...__ _-_- . . _- ___. _.-- - _700--_-236.10 __-.00 -._.-.T00-_-78337 r 01 000 Jim Gilman Excavating. Inc. DATE 5/19/17 FRP314 3099 Grand Ave. TIME 12:55 PAGE 7 Batter-_ __.__NT-597016337 . .. H 406-723-8234 FED I0$ 81-0300860 'PAGE 2-OF-_-PAYROLL-NOi-__ _. _.- CERTIFIED-PAYROCCREPORT-'.-___-_ _.. WEEK SWING - 05/14/2017.___. .____._ _______ ___. Job 875 KOUNTZ ROAD BRIDGE TANIETTI CONSTRUCTION WAGE DECISION NO 2014 00 __ _.REPLACEMENT- _..__._ ___--PO-BOX 6547...... _____----_-_-_ _____.___CONTRACT..NUMBER_.RRG-14-1561. .GREAT FALLS MT 594066547 CONTRACT START 09/26/2016 -- THIS Job -- THIS WEEK ----- {BURS WORKED THIS Jab - TX TVL CHK DATE FICA SDI TOT PAY WORK S ____ 5/ 5/ 5/ ____5/_---5/---5Y 5/--__..__ _._._NTX_TVL_--BENEFITS- FED W/T_.. UNION ..TOT..DED ADDRESS CLASS- E MIN 08 09 10 11 12 13 14 TOT TY PAY TX ADJ SCK PAY ST W/T OTHER NET PAY -,ZIP CODE/ SOCIAL SEC:/ EXM IFICATION X CIE HON TUE WED THU FRI SAT SUN HOUR HR RATE NTX ADJ TOT PAY LOC W/T SUT W/T CHECK : _`.-UNH- 007 01...H d W TEAMSTERS _-42:00. UNB 007 -02._PENSION TEAMSTR .......11.76 ._..UND 007..-_01_Hd..WTEAtISTERS .__.297.50 ▪ UND 007 02 PENSION TEAMSTR 83.30 IRO) 007 05 TEAMSTR NW FUND 2.99 RUDY-L-JONES.---_._D OPER SCZIM 0 .800._-.00__ ;00__._-00-_..00---.00- .00_.8.00 ST 27.260✓ 00 051917 95793 .__.00.....1621.71. v-0PER 3 - ZI .50 .00 .00 .00 .00 .00 .00 .50 0V 40.21500 81.18 240.51 413.68 817.25 66-D..Heri,ma-) .00 .00 .00 67.13 .00 804.46 1. - II:._ XXX-XX-0478-00 ___ -__.__ 00 __ __ _ _._.___-_ _. _...__. :00 _-319.37 __... 00 00 .__.78338. UNB 001 01 H S W OPERAET 53.98 IN) 001 02 PENSION OPERATR 17.00 UM) 001 03 VACATION OPERTR 8.50 _ . ._. M-001 04-APPRENT OP R -1.70._ _.__._UND--001-01 HS-W-OPERATOR 273.06 UND 001.__.02--PENSION-OPERATR _-__.86.00 UND 001 03 VACATION 44300. HD 001 04 APPRENT OPERATR 8.60 UND 001 05 OPERTOR NW FUND 3.02 j-OWEN W ROGERS -_---OPER-3--Z.211.y/ 6 _x. .00 .00. . 00 :00 -_..00--.00__--00.. 00-ST-29.760'/ .00__..._051917 _. 97.38 _.00 _-1644.83. _._. _... - .00 .00 57.30 225.22 418.50 009.36 .00 .00 .00 68.26 .00 835.47 _ XXX-XX-6805 .00 _.___ 00- _-- ___._._ _. .00 _.-__235.86 -____..00 _...00 . 78340 ~.z.▪ UND 001 01 H & W OPERA 38.10 UNB 001 02 PENSION OPERATR 12.00 UNB 001 03 VACATION OPERTR 6.00 . . UNB 001_--_M_-APPRENT_ ATR -_-.__1.20 _ 11140 001._._01-N-4 p-OPERATOR---_276.24-__-.UND-001--02--PENSION OPERATR .....87.00 UND 001 03 VACATION TR 43.50 UND 001 04 APPRENT OPERATR 8.70 UND 001 05 OPERTOR NW FIRM 3.06 -400--__051917.___-_100.52_. .00 1694759. 7. -JACK _.. __-OPER 3_-21_0- 6..00_-;0000-.:00_ .00 .00 .(10 6.00 ST-29.760/400- __... .00 .00 57.30 49.09 428.12 628.73 .00 .00 .00 51.00 .00 1065.86 _�__.____XXX-XX=6312 09-_._ _.00- - -..__.____ ___ _ .00 235.86 _._._100 __._:00 _.. ..78348 '- UNB 001 01 H 6 W OPERA R 38.10 UNB 001 02 PENSION OPERATR 12.00 UID 001 03 VACATION OPERTR 6.00 ^,._UND-001-04--APPRENT TR- ---1.20 UND 001 01__H-&-W-OPERATOR- ._._28-459-_-._UND-001_....02 PENSION OPERATR----- 89.00 UND 001 03 VACATION RTR 44.50 URID 001 04 APPRENT OPERATR 8.90 IBID 001 05 OPERTOR NW FUND 3.13 T DARRELL YAGER _---- - RKDRIVERVU11jj 0.._....8.00-.00-_ .00 _..00. .00_. -.00 _.00-8100 ST-30.390.00-___.051917-.._.110.42 .00 1882:41_. ._._._ Z-0_ .00 .00 71.68 173.62 442.49 905.02 .00 .00 .00 78.49 .00 1077.39 .,' XXX-XX-1275--00----- - __ __-_.00- m0 _..__-_ -__ ___._ _ ___.___ 0 314.80_._.. 00 __.. .00 78349._ UNB 007 01 H 6 W TE�ERS 56.00 VHS 007 02 PENSION TF1d45TR 15.68 1840 007 01 H 8 W TEAMSTERS 343.00 _-UND- --02-PENSION TR ..96.04 __.-_UND-007-05-TEAMSTR-NW-FUND 3.45- ▪ Job i&T A L S .._._-- - ___--T-O T A_L--H O U R S T H I S--W EE-K- __--TOT__TY_ HRS HR - - i 57:50- -.00-_____...00 .00.__ .00 .00--300_.____57:50__ST 1.50 .00 .00 .00 .00 .00 .00 1.50 0V 01 000 Jon GI lean Excavating, Inc. DATE 5/19/17 PRP314 3099 Grand Ave. TIME 12t55 PAGE 8 - Witte,._....._- MT 597016331 . __-_-_- y 406-723-8234 FED ID* 81-0300860 Ili,_PAGE--3-0F=-PAYRCL1-HD_ - _ CERTIFIEIFFATMAL HLHORT _ . . _. WEEK-ENDING =0571a7201T_ _._ _________-__-_____ -I Job 875 KOID4IZ ROAD BRIDGE TAMIETTI CONSTRUCTION WAGE DECISION NO 2014 DB - r, __._REPEACEHEM--- PO-BOX 6547. _ CONTRACT-NUMBER RRG-14-1561 ._.._ ., 2,. GREAT FALLS MT 594066547 CONTRACT START 09/26/2016 a - THIS Jab -- ------- THIS WEEK ------ i -` --- HODS WORKED THIS Jab TX Pk CIAO DATE FICA SDI TOT PAY •. j NAME- ______-_--WORK -S _-5/.__._5T 5/.._..-5/_ 57_-5/--5/._ _ ---tiX-.NL_-.-BENEFITS FED W/T -ONION TOT.DED _ _._. 'iii. ADDRESS CLASS- E MIN 08 09 10 11 12 13 14 TOT TY PAY TX ADJ SCK PAY ST W/T OTHER NET PAY ZIP CODE/ SOCIAL SECO/ EXM IFICATION X CDE MON TUE (ED THIJ FRI SAT SUN HOUR IR RATE NIX ADJ TOT PAY LOC W/T SUT W/T CHECK 4 H, TOTAL DOLLARS THIS WEEK TX TOL_..... NIX Tt TX-A07—NTX-AWJ_--BENEFITS.___HI PAY...... SICK PAY. TOTAL PAY .00 .00 .00 .00 547.24 .00 2320.85 I ...__- q,. MINORITY CODES 0-UNDERTERMIED 1-AFRICAN AtERICN 2-HISPANIC 3-NATIVE AMERICAN 4-ASIAV 5-PACIFIC ISLANOR 6-CAUCASION - Frank Austin/7 Tim Fisher James C.Gilman Jr. Trevor J.South / 000-00-9295.e--- 000-00-5194 000-00-Sliili" 000-00-8503 --Salaned_Supervisor/Safety -- - Salaried SSpeivisor--- - Salaried Supervisor--- -- - Tester 3 - STATEMENT OF COMPLIANCE Dare May 22.2017 LaRae South Payroll Secretary dohercbysam: (Name of Signatory Party) (foe) p) That I pay or supervise the payment of the persons employed by Jim Gilman Excavating.Inc .on (Contractor or subcontractor) the Kountz Road Bridge Replacement that dining the payroll period commencing on the 8th day of May and ending the 14t -1 day of May - 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 Contractor from the full weekly wages earned by any person and that no deductions have (Contractor or Subcontractor) 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.276c)and described below: FICA Withheld Federal Withholding Tax Withheld Montana Withholding Tax Withheld Vacation Allowance Withheld 401(k)Deferrals (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less that the applicable wage rates contained in any wage determination incorporated into this 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: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS -▪ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,payments or 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. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each Laborer or mechanic listed in the above referenced payroll has been paid as 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,except as noted in section 4(c)below. (c) EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION REMARKS PAID TO Operator Fringes-H&W$6.35,Pension $2.00,Vacation$1.00 Montana OE-C.I.Trust Fund Appren$20,MLMA(Deduct)$.07. PO Box 31278 Billings,MT.59107-1278 Teamster Fringe-H&W$7.00,MLMA(Deduct)$.07 Montana Teamsters Contractors/Employers Trust PO Box 515196 Los Angeles,CA.90051-5196 Teamster Fringe-Pension$1.96 Western Conference of Teamsters Pension Trust PO Box 30480 Seattle,WA.98124-1080 Laborer Fringes-H&W 5.65,Pension$2.00,Vacation$1.00 Laborers-A.G.C.Trust of Montana Appren$.25,MLMA(Deduct) $.07 PO Box 31278 Billings,MT.59107-1278 "Indicates Individual is Mobilizing Equipment. Wage Rates Not Contingent to Project Wages. SHIFTING Operators $1.35 Shifted From Fringes To Wages - Teamsters $0.20 Shifted From Fringes To Wages Laborers $0.15 Shifted From Fringes To Wages . Payroll#1 ' Effective 4/5/99-Operators&Laborers Vacation$I.00ihr. NAME AND TITLE SIGNATURE `t/ f b_c LaRae South-Treasurer 6.7\41,44._ TIM WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CUM OR CRIMINAL PROSECI TON SEE SECTION 1001 0F TITLE 18 AND SECTION 231 OF 1111E 31 OF THE UNITED STATES CODE NJ .4 a r a [ 4. Ja1ir1Jrani ' , libri.:-A 875 Fringe and Deduction Breakdown 2016 State Highway Rates Effective January 2, 2016 Operator Union Fringe Vacation 1.00 Deducted from hourly wage after taxes H &W 6.35 MLMA .07 Deducted from hourly wage after taxes Pension 2.00 Appren. .20 8.55 SH Fringe 9.90 1.35 Shifted from fringe to wage Teamster Union Fringe MLMA .07 Deducted from hourly wage after taxes H & W 7.00 Pension 1.96 8.96 SH Fringe 9.16 0.20 Shifted from fringe to wage Laborer Union Fringe Vacation 1.00 Deducted from hourly wage after taxes H &W 5.65 MLMA .07 Deducted from hourly wage after taxes Pension 2.00 Appren. .25 7.90 SH Fringe 8.05 0.15 Shifted from fringe to wage Calculation: SH Wage +/- Shifted amount- Vacation if applicable = Hourly Wage shown on payroll. MLMA is deducted out of total net wages. Example: Operator Group 3 26.91 + 1.35(9.90 SH Fringe - 8.55 Union Fringe) = 28.26 - 1.00 Union Vacation = 27.26 Hourly Wage. MLMA is then deducted from the employees'total net wages. An Equal Opportunity Employer 3099 GRAND AVE. • BUTTE, MONTANA 59701 • (406) 723-6349 OR 723-8234 • FAX (406)723-6778 j 01 000 die Gilman Excavating, Inc. DATE 5/19/17 PRP3I4 3099 Grand Ave. TIME 12755 PAGE 6 - utter _ _. MT 897016337_. -.__.___-__ _ _-_._ _- _._ ____ _____ ' - 406-723-8234 FED ID: 81-0300860 ,,..,PAGE- 1--OF-_..PAYROLL-Ntr1 _-_- ____ --.._EERTIFIED-PAYROLL-REPORT _._.__-_- -.__WEEK_ENDING- 05/14/2017 - Job 875 KOUNTZ ROAD BRIDGE TAMIETTI CONSTRUCTION WAGE DECISION NO. 2014 DB _REPLACEMENT _-_.-_ PO BOX 6547.. __-__ _-_.______ _._..___CONTRACTNUMBER--RAG=14-156I -... _____. _ __._. -.. GREAT FALLS MT 594066547 CONTRACT START 09/26/2016 - HOURS WORKED THIS Job ------- TX TVL QI( DATE FICA SDI TOT PAY -NAME -"___.. ___.. WORK--T__... ..5/--_5/_. 5/ 5/----57 _Fir___-5r _. _ NTX TUC BENEFITS_.__FED W/T -.___UNION TOT OED._ ADDRESS CLASS- E MIN 08 09 10 11 12 13 14 TOT TY PAY TX ADJ SCE PAY ST W/T OTHER NET PAY ZIP CODE/ SOCIAL SEC./ EXM IFICATION X CDE MON TUE WED THU FRI SAT SUN HOUR H RATE NTX ADJ TOT PAY LOC W/T SUT W/T CHECK C Timmy L BOULTER OPER 3 - ZDF 0 5.50 .00 .00 .00 .00 .00 .00 5.50 ST 29.760 .00 051917 59.06 .00 1002.91 _ - .00 .00 52.53 72.92 259.78 429.97 .00 -____._-___...___ __- . _.. .00__------'700-_-_.38121 _.00 -_._572:94_. XXX-XX-5822 00 .00 .00 216.21 .00 .00 78329 -,___UNB-001 -01-H-8-W-OPERATOR. -34193 - _______ -001----02- PENSION-OPERATR ---11 00-----UL0 001_-. 03 VACATION OPERTR _.--5.50._ UNB 001 04 APPRFNT OPERATR. 1.10 UND 001 01 H 8 W OPERATOR 171.47 UND 001 02 PENSION OPERATR 54.00 _ - UND 001 03 VACATION OPERTR 27.00 UND 001 04 APPRENT OPERATR 5.40 U140 001 05 OPERTOR NW FUND 1.91 WILLIAM CARELLI TRKDRIVER M 0 4.50 .00 .00 .00 .00 .00 .00 4.50 ST 30.390 .00 051917 13.79 .00 234.04 .00 .00 40.32 1.39 54.19. 73.80 ,,j-. .00 __-____ _-_. ____-_-_ __... _____-_- ,00--." .00 --__-4,43 .._100 -._160.24 XXX-XX-9186 00 .00 .00 177,08 .00 .00 78330 i _-.UN6-007--01- H BW-TEAMSTERS.. ---31.50 _---DNB-007--0T'-PENSION-TEAPSTR 8.02 ..._.TAT .007.."-01"-H-S-W-TEAMSTERS ...42.00 UND 007 02 PENSION TEAMSTR 11.76 UND 007 05 TEAMSTR MAd FUND 0.43 MIHONY-GARDIPEE_._.._..__-OPER 3 - Z;M 0 __.5.50 .00 X00-__.00_ ....00 -100 .00-_5.50"ST"29:760-_ .00..__. 051917 ..__._89.89 .__.00.._.1525.61 .00 .00 52.53 121.69 394.44 666.22 .00 .00 .00 60.20 .00 859.39 , XXX-A-7796-.or _.-_---._. .00 --_____ -._._.__ - _-. -_.- 00 .216.21_._. .00 ._..0078335.__... OT 001 01 H & W OPERATOR 34.93 LIND 001 02 PENSION OPERATR 11.00 UNB 001 03 VACATION OPERTR 5.50 1;--LAND 001--__04__APPFENT OPERATR -_-..--1710 _-----11ND 001 01----H-6-W-OPERATOR __---260.36 UND 001 02...PENSION OPERATR .....82.00 UHF 001 03 VACATION OPERTR 41.00 UT 001 04 A11-n7:NT OPERATR 8.20 UHF 001 05 OPERTOR NNE FLAT 2.88 2.-X I T. RONALD J-HENDRICKSON____..-Tfd(DRIVER M 0----8.00_-_TOO_.__.00--.00- -.00 .00 .00---8.00-ST-30.390_-_ .00 _-.._051917 115.13 _.-.00 __.1970.96. TRKDRRIVER 1.00 .00 .00 .00 .00 .00 .00 1.00 OV 45.590 ,00 80.64 263.78 469.60 928.50 L 2-1, .00 .00 .00 79.99 .00 1042.46 ,- -.._ .-"XXX-XX-9221 01- -. ______-._.00. __._-_ __ __-_- -._- .00---_---369135 --_-_X00. '.00 __--_78336_ -i 4178 007 01 H 6 W TEAMSTERS 63.00 UNB 007 02 PENSION TEAMSTR 17.64 UND 002 01 H&W TEAMSTERS 42.00 -(RI._002 02--PENSION IF AM STR_----11.76- --_.UND 002 05-TEAMSTR-NA7.-FUND__---__0743_ UND 007 -01--7rlW-TEAMSTERS___.-322,00 - UND 007 02 PENSION TEAMSTR 90.16 ONO 007 05 TEAMSTR NW FUND 3.25 TIMOTHY J HOBART--___---TRKDRIVER M 0_.-_.6700--.00--:o0-00--_.00- .00_.._-.00--6700-ST-307390-- or 051917 _-90.39.-__-.00 ._1562.47. _... _ __.. _. _. a-� .00 .00 53.76 134.37 383.79 671.33 .00 .00 .00 62.78 .00 891.14 ---- N=o751--00-_-__ -.00-- ----- --- _----- ------.00---236.10 -.._..00-----.00-----78337 - XXX- 01 000 Jim Gilman Excavating. Inc. - DATE 5/19/17 PRP314 3099 Grand Ave. TIME 12t55 PAGE 7 ___-- _____._ -. . _ _.. ____-.Butte:___-___---MT`59701b337- -.. 1. 406-723-8234 FED ID4 81-0300860 I -PAI ._ 2-OP- --PAYROLL-NCI. -CERTIFIED-PAYROLt-REPORT----.- __-_---_.--__-WEEK-ENDING-=-05/14/2017_._. Job 875 KOONTZ ROAD BRIDGE TAMIETTI CONSTRUCTION WAGE DECISION NO 2014 D8 _. _...... REPLACEMENT- -__.- ----PO'BOX 6547 _ _.. - CONTRACT OMBER RRG-14-1561. GREAT FALLS. MT 594066547 - CONTRACT START 09/26/2016 -. -- THIS Job -- ---------- THIS WEEK ----- ----- HOURS WORKED THIS Jab ----- TX TVL CHIC DATE FICA SDI TOT PAY WORK __-S-._--SY__.-5/-_-5-/---5/ -_5/---51 51 _. _.-NTX TUC --BENEFITS.. --FED-W/T ..__UNION ..TOT.DED._ ADDRESS CLASS- E MIN 08 09 10 11 12 13 14 TOT TY PAY TX ADJ SCK PAY ST W/T OTHER NET PAY `,-ZIP CODE/ SOCIAL SECS/ EXM IFICATION X CIE HON TUE WED THU FRI SAT SUN HOUR HR RATE NTX ADJ TOT PAY LOC U/T SUT W/T CHECK _UNB- 007.-..01--H 6W TEAMSTERS.. - -.42.00 UNB .007-._..02. PENSION-TEAPSTR -_-_.. 11776--.-._UDI-007-_01..-H SW TEAMSTERS .__.297.50 - UND 007 02 PENSION TEAMSTR 83.30 IND 007 05 TEAMSTR NW FUND 2.99 • RUDY-L-JONES_.--.-*OPER3--ZIN_0_-8700-....00___.00--.00- -:00-.:DO-.'....00.___8:00ST27.260._ 00 _._"051917-_._._95.93 ..-._...00 1621771_ DOPER 3 - ZN .50 .00 .00 .00 .00 .00 .00 .50 OV 40.215 .00 81.18 240.51 413.68 817.25 (3E ls - tt4aric..4-) .00 .00 .00 67.13 .00 804.46 ` XXX-XX-0478 -00--.... --. 400 ___. __. -._.. .00 319.37 .00 .00 .78338. __ _. -_.. • UNB 001 01 H 6 W OPERATOR 53.98 in 001 02 PENSION OPERTTR 17.00 4148 001 03 VACATION OPERTR 8.50 tRtlB-001-04-APPRENT OPERATR -1.70 __-__-UN0--001_-._01_._H--,tW-OPERATOR---_-273:06-_._.-UN.-001--02-PENSION-OPERATR _.___86.00 -.-..__. . - UND 001 03 VACATION OPERTR 43.00 UN 001 04 APPRENT OPERATR 8.60 UND 001 05 OPERTOR NW FUND 3.02 OWEN-W ROGERS -_-_ __-OPER.3 -Z1Pi-0-_--600----.00-- .00---.00 .00 --.00- - .00 6.00 ST 29.760 .00 051917 - .. .97.38 400" 1644.83.. .00 .00 57.30 225.22 418.50 809.36 �i- .00 .00 .00 68.26 .00 835.47 XXX-XX-6805_00.-.. __-. .00 -_-_._ - ________--_ - .-_._. __ -- _235:86-- _ .00 _-_. -.00 -_7834D_._ UNB 001 01 H 6 W OPERATOR 38.10 UN 001 02 PENSION OPERATR 12.00 OMB 001 03 VACATION OPERTR 6.00 ._.DNB_.001 -04--APPREM-0PERATR .___.x•20 _. -_UND-001--01-HAW-OPERATOR ._.._.276.24... -UN..001 -.02- PENSION-OPERATR .. .87.00 UND 001 03 VACATION OPERTR 43.50 UN 001 04 APPRENT OPERATR 8.70 UND 001 05 OPERTOR NW FUN 3.06 , JACK H UARD -...- OPER 3 - ZJj 0 6.00 .00 .00 .00 .00 .00 _...00..6.00 ST 29.760-_X00-__051917 __.100.52 .00 1694.59 .00 .00 57.30 49.09 428.12 628.73 .00 .00 .00 51.00 .00 1065.86 XXX-Xf(--6312-09-.___.--_- .00 -_-__-_. _ __ ._._______ -__-__. .00.__.__-235.86 ._.___..00 _- _ .00 -. .-78348_- __.. . 4. UNB 001 01 H & W OPERATOR 38.10 UN 001 02 PENSION OPCRATR 12.00 UR 001 03 VACATION °Palm( 6.00 • UN-001--04-APPRENT`OPERATR___.__.._1.20__-_____UND-001..-._01 -HS-B-OPERATOR--____282-.59_.-._tRM-001-_._02-PENSION-BPERATR- - 89.00 • UND 001 03 VACATION OPERTR 44.50 UND 001 04 APPRENT OPERATR 8.90 UPN 001 O5 OPERTOR NW FUND 3.13 i DARRELL YAGER---.- --_._TRKDRIVER M 0___.8.00 _..00._ .00 .00_-_. .00 400 .00 8.00 ST 30.390....-. .00 051917 110.42 .00 1882.41 __. -___ _... ._ . I Z'n-_ .00 .00 71.68 173.62 442.49 805.02 El .00 .00 .00 78.49 .00 1077.39 i1XXX-XX-1275.00 .00. -. ___ _ - _ - -X00---314.80 _-.._. 00 _...00_...-..78349 UNB 007 01 H 6 W TEAMSTERS 56.00 DNB 007 02 PENSION TEASTR 15.68 UND 007 01 H 6 W TEAMSTERS 343.00 n'. 0448-007.-02-PESION TEAMSTR __.96.04_.--____DID-007_:-05-TEANSTR-tNW-FU4D 845 .__.. ___-- ?- Job TOTALS--_-- _.-__-__T-O-T A-L-H-O-U R -T H-TS-WEEK----- -- TOT TY - __ _ _-. ___ __--. _. _. ._ __-____.- HR6 HR _-'',r 57.50. -""--.00- .00-----a00 .0000 .00___- 57.50...ST._ 1.50 .00 .00 .00 .00 .00 .00 1.50 OV -- --- 01 000 Jim Gilman Excavating, Inc. DATE 5/19/17 PRP314 3099 Grand Ave. TIME 12555 PAGE 8 ii.. _... -- Bette, MT 597013337" 406-723-9234 FED IDr 81-0300860 7`PARE- -3.OF..____--PAYROLL NO=_ _:_.. __—CLRTIFIED-FAYROCI=REPORT— ___-- WEEK-ENDING--=05/14/2017 i7 Job 875 KMJNTZ ROAD BRIDGE TAMIETTI CONSTRUCTION WAGE DECISION NO. 2014 DB REPLACEMENT ___—_ —. PO-BOX654T.._ _.—. —_ -CONTRACT MIMBER. RRG-14-1561_...__— GREAT FPJIS MT 594066547 CONTRACT START 09/26/2016 — — THIS Job -- — THIS WEFJC ------- �y ( HOURB WORKED THIS Job ------ TX TVL CHIC DATE FICA SDI MT PAY ,-NAME __._. .._WORK —G._---SY--5/—_._5/ 5/.._._5/--5r—_s-r—--- _ NTX-M BENEFITS_—_FED-W/T".__..TRITON.__.TOT DEO ADDRESS CLASS- E MIN OB 09 10 11 12 13 14 TOT TY PAY TX ADJ SCK PAY ST W/T OTHER NET PAY ZIP CODS/ SOCIAL SECS/ EXM IFICATION X CDE MON TUE WED THU FRI SAT SUN HOUR HR RATE NTX ADJ TOT PAY LOC W/T SUT W/T CHECK TOTAL DOLLARS THIS WEEK _"TX-TVL_._NTX TVL TX AOJ__--NTX-ADr BENEFITS -IOC PAY SICK PAY ..TOTAL PAY .00 .00 .00 .00 547.24 .00 2320.85 MINORITY CODES 0-IBMERTERMItED 1-AFRICAN AMERICN 2-HISPANIC 3-NATIVE AMERICAN 4-ASIAN 5-PACIFIC ISLANDR FF- 6-CAUCASION - =1 Frank Austin Jim Fisher James C.Gilman Jr. Trevor J.South 000-00-5194 000-00-5618 000-00-9295 000-00-8503 Salaried Supervisor/Safety Salaried Supervisor"-"" - --- - Salaried Supervisor — - - - Tester -- " - -- d 1J