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2010-0932010-93 Resolution Authorizing Change Order No. 4 for the Highway Garage HVAC Project At a regular meeting of the Town Board of the Town of Wappinger, Dutchess County, New York, held at Town Hall, 20 Middlebush Road, Wappingers Falls, New York, on February 22, 2010. The meeting was called to order by Christopher Colsey, Supervisor, and upon roll being called, the following were present: Bettina. PRESENT: Supervisor Councilmembers ABSENT: Christopher J. Colsey William H. Beale Vincent F. Bettina (arrived at 7:01 PM) Ismay Czarniecki Joseph P. Paoloni The following Resolution was introduced by Councilman Beale and seconded by Councilman WHEREAS, the Engineers to the Town, Morris Associates Engineering Consultants, PLLC, have approved Change Order No. 4 to the Contract for the Town of Wappinger Highway Garage HVAC Project, as per letter dated February 4, 2010, a copy of which has been provided to the Town Board in advance of this resolution. NOW, THEREFORE, BE IT RESOLVED, as follows: 1. The recitations above set forth are incorporated in this Resolution as if fully set forth and adopted herein. 2. The Town Board hereby approves Change Order No. 4 in the amount of One Thousand, Six Dollars and 25/100 ($1,006.25), dated February 1, 2010, for the Town of Wappinger Highway Garage HVAC Project Contract between the Town of Wappinger and Airflow Air Conditioning, Refrigeration & Heating, Inc., resulting in a new Contract sum in the amount of Two Hundred Fifty -Seven Thousand, Four Hundred Eighty Dollars and 25/100 ($257,480.25), for the reasons and associated costs set forth in the letter dated February 4, 2010, from Morris Associated Engineering Consultants, PLLC. The foregoing was put to a vote which resulted as follows: CHRISTOPHER COLSEY, SUPERVISOR Voting: AYE WILLIAM H. BEALE, COUNCILMAN Voting: AYE VINCENT F. BETTINA, COUNCILMAN Voting: AYE ISMAY CZARNIECKI, COUNCILWOMAN Voting: AYE JOSEPH P. PAOLONI, COUNCILMAN Voting: AYE Dated: Wappingers Falls, New York 2/22/2010 The Resolution is hereby duly declared adopted. a( JOHN C. MASTERSON, TOWN CLERK 0 MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC * 9 Elks Lane, Poughkeepsie, New York 12601 Tel: (845) 454-3411 Fax: (845) 473-1962 ❑ 64 Green Street, Suite 1, Hudson, New York 12534 Tel: (518) 828-2300 Fax: (518) 828-3963 February 4, 2010 Town of Wappinger Town Board Town Hall 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Hon. Christopher Colsey, Supervisor RE: Highway Services Garage HVAC Project Roof Repair over Garage #1 Change Order #4 Dear Mr. Colsey and Town Board Members: Enclosed please find a copy of Change Order #4. This change order was necessitated after removal of the existing roof material additional areas of the roof sheathing were found to be rotted and in very poor condition. The sub -contractor removed and replaced a total of 5 additional sheets of plywood as well as installed 2" x 10" x 10' for rotted roof joists; and primed fascia. The contractor, Airflow Air Conditioning, Refrigeration & Heating, Inc. provided the cost for material, demolition and installation as shown in the attached Change Order. The amount provided is $1,006.25. Therefore, the new contract total will be $ 257,480.25 ($256,474.00 + $1,006.25 = $257,480.25). Please place this on the agenda for the February 22, 2010 Town Board Meeting for approval of Change Order #'4. Please call me at (914) 475-5749 (cell) or (845) 454-3411 Ext. 30 (office) to discuss this matter prior to the meeting. RJG/met Enc. Cc Albert Roberts, Town Attorney John Masterson, Town Clerk Graham Foster, Highway Superintendent Inez Maldonado Very truly yours, MORRIS ASSOCIATES Engineering Consultants, PLLC Robe . Gr • , PI7 4 Engineer to the Town of Wappinger MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC A 9 Elks Lane, Poughkeepsie, New York 12601 Tel: (845) 454-3411 Fax: (845) 473-1962 ❑ 64 Green Street, Suite 1, Hudson, New York 12534 Tel: (518) 828-2300 Fax: (518) 828-3963 February 4, 2010 Town of Wappinger Town Board Town Hall 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Hon. Christopher Colsey, Supervisor RE: Highway Services Garage HVAC Project Roof Repair over Garage #1 Change Order #4 Dear Mr. Colsey and Town Board Members: Enclosed please find a copy of Change Order #4. This change order was necessitated after removal of the existing roof material additional areas of the roof sheathing were found to be rotted and in very poor condition. The sub -contractor removed and replaced a total of 5 additional sheets of plywood as well as installed 2" x 10" x 10' for rotted roof joists; and primed fascia. The contractor, Airflow Air Conditioning, Refrigeration & Heating, Inc. provided the cost for material, demolition and installation as shown in the attached Change Order. The amount provided is $1,006.25. Therefore, the new contract total will be $ 257,480.25 ($256,474.00 + $1,006.25 = $257,480.25). Please place this on the agenda for the February 22, 2010 Town Board Meeting for approval of Change Order#'4. Please call me at (914) 475-5749 (cell) or (845) 454-3411 Ext. 30 -(office) °to discuss this matter prior to the meeting. Very truly yours, MORRIS ASSOCIATES Engineering Consultants, PLLC 7 Robe . G4, PE Engineer to the Town of Wappinger RJG/met Enc. Cc Albert Roberts, Town Attorney John Masterson, Town Clerk Graham Foster, Highway Superintendent Inez Maldonado Feb 02 10 02:06p AIRFLOW aw—s�-RFLO 06, eaw6are XW' wJdo-w- 6 Xsd4 o. -q- p.o. Box 941 Highland, NY 1248 Ph one- (845)795-5740 Fax:(845)795-5742 CHANGEORDEF wwu.airnawnircorxlitiauin;.corn 8457955742 p•2 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ OTHER ❑ PROJECT: Town of Wappinger CHANGE ORDER #: 4 Highway Garage HVAC Irnprovements,Firewa CHANGE ORDER DATE: 02101/2010 20 Middlebush Rd 09-005 Wappingers Falls, NY 12590 PROJECT #s: TO: Airflow Air Conditioning, Refrigeration & Heati DATE OF CONTRACT: 09/2112009 PO Box 941 FOR: Highland, NY 12528 The Contract is changed as follows: 1- Labor and materials as follows - it was determined that additional rotted plywood had to be removed and replaced w new. After removal of roof, Replaced 5 sheets plywood with new, furnished and installed new 2 x 10x 10, cut to 30" for rafters & primed fascia. Net Change Order #4 cost - Materials & Labor =$ 875.00 15% allowable override percentage (on site costs only) =$ 131.25=$1 006.25 Change Order #4 Lump Sum Total The original Contract Sum was The net change by previously authorized Change Orders is $240,650.00 $15,824.00 $256,474.00 The Contract Sum prior to this Change Order was $1,006.25 The Contract Sum will be increased by this Change Order in the amount of $257,480.25 The new Contract Sum including this Change Order will be 0 days. The Contract Time will be increased by 0 2/1/2010 The date of Substantial Completion as of this Change Order therefore is Not valid until signed by all parties below. T f Wa Inger Morris Associates ARCHITECT 9 Eks Lane NY 12601 y (Signature) Robert Gray (Typed Nam/ne �) ,, DATE '[/J Airflow Air Conditioning, Refrigeration a, Heau own o r r CONTRACTOR OWNER PO Box 941 20 Middlebush Rd ADDRESS ADDRESS Highland, NY 12528 BY (Signature) - (Typed Name) DATE Wappingers Falls, NY 12590 BY (Signature) (Typed Name) DATE 4 N Toiat_ I Ii 090 d ■' rwlww MnNa. tridd�hNNirar,�g• eitMreil�ww►iacw�rb+Nai `� N4'N•nNnolM+eiN.d;ai+dlMtYii•�nioinit��bMborlbn'•�wrMrrlql�yonbdpNMIMO:NMmMRM�ONn�Ipw . ,B��iw �Mu:ThrtNaw.lran the Candke Duridn .• 8t01�TlIpE TRL,� (GPACgj 1ft-0 ftR MNN0DAL WM t1 a 881VICdB 01:MBi9d8ft� WAm I'a•�ii`�efad �mieh to the munici or Aa ity on tf�e dattaia stated ani �6rge are COrTOCt . OWA 'A $D OFFICIAL APMOVAL iOR PAYMENT. The edam is q* m pw noun ow sp000 rdarr4lnerorl.a.t�v. aArC cokimoiL— rage G/G OWN op 'WAPP. 324% MlddtNs�iltr�% Onn►eIa w4wnpers FaA4. MY. -1 6011, ooN!I' WFMgx py bits attic P RCHASE •%Doi aMwe Ci�iD p $:V060HER FUND.— PH V 0 cw►,wire NAMEAHD ;�►;'t.V ` 6 7 ADRgEtJli j P.O. Boz m }Ughbod, NV 12528. ! Phony (945)79S•S740 Fuc (345)79S•S742 ' • ""'VIA Wkweirconditioniag.can, Emni4•:drrlowncrhtncg)noLcom ff — -- A6BTW4CT N0. TOM TiRm ' •• fIfF.NO. OAS IS '7.1,/! QUANTITY 3C° yq ON #MAT 94i1$ 6RVIC� 1 � A09Vr 1�� /�f�l��/' UNR FWOE AMOUNT , Toiat_ I Ii 090 d ■' rwlww MnNa. tridd�hNNirar,�g• eitMreil�ww►iacw�rb+Nai `� N4'N•nNnolM+eiN.d;ai+dlMtYii•�nioinit��bMborlbn'•�wrMrrlql�yonbdpNMIMO:NMmMRM�ONn�Ipw . ,B��iw �Mu:ThrtNaw.lran the Candke Duridn .• 8t01�TlIpE TRL,� (GPACgj 1ft-0 ftR MNN0DAL WM t1 a 881VICdB 01:MBi9d8ft� WAm I'a•�ii`�efad �mieh to the munici or Aa ity on tf�e dattaia stated ani �6rge are COrTOCt . OWA 'A $D OFFICIAL APMOVAL iOR PAYMENT. The edam is q* m pw noun ow sp000 rdarr4lnerorl.a.t�v. aArC cokimoiL— MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC 9 Elks Lane, Poughkeepsie, New York 12601 Tel: (845) 454-3411 Fax: (845) 473-1962 64 Green Street, Suite 1, Hudson, New York 12534 Tel: (518) 828-2300 Fax: (518) 828-3963 February 11, 2010 Town of Wappinger Town Board Town Hall 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Hon. Christopher Colsey, Supervisor RE: Highway Services Garage HVAC Project Application & Certificate for Payment #4 Dear Supervisor Colsey and Town Board Members: Enclosed please find the Application and Certificate for Payment #4 in the amount of $56,090.85 which reflects the 5% retainage of $2,804.54 as submitted by Airflow Air Conditioning, Refrigeration & Heating, Inc. The total completed and stored to date, including retainage, is $255,174.00. Also, attached is the Town of Wappinger Purchase Order & Voucher form and copies of Certified Payrolls. This office has reviewed the Certified Payrolls and found them to be in adherence with the Prevailing Wage Rates in the Bid Document. Please place this on the agenda for the February 22, 2010 Town Board Meeting for approval of a resolution to disburse the amount certified. Please call me at (914) 475-5749 (cell) or (845) 454-3411 Ext. 30 (office) to discuss this matter prior to the meeting. Very truly yours, MORRIS ASSOCIATES Engineering ConsultantPLLC Illy Robert . ra , E�'u.� Engineer to the Town of Wappinger RJG/met Enc. Cc Albert Roberts, Town Attorney John Masterson, Town Clerk Graham Foster, Highway Superintendent Inez Maldonado i PAYMENT APPLICATION ADDITIONS DEDUCTIONS Total changes approved in previous months Page 1 TO: Town of Wappinger PROJECT Town of Wappinger APPLICATION # 4 Distribution to: 20 Middlebush Rd Falls, NY NAME AND LOCATION: Highway Garage HVAC Improvements,Firewall PERIOD THRU: 01/29/2010 OWNER Wappingers 12590 Attn: 20 Middlebush Rd PROJECT tis: 09-005 ARCHITECT Wappingers Faits, NY 12590 FROM: Airflow Air Conditioning, Refrigeration & Heating ARCHITECT: Morris Associates DATE OF CONTRACT: 09/21/2009 ❑ CONTRACTOR PO Box 941 9 Elks Lane ❑ Highland, NY 12528 Poughkeepsie, NY 12601 ❑ FOR: CONTRACTOR'S SUMMARY OF WORK Application is made for payment as shown below. Continuation Page is attached. 1. CONTRACT AMOUNT 2. SUM OF ALL CHANGE ORDERS 3. CURRENT CONTRACT AMOUNT (Line 1 +1- 2) 4. TOTAL COMPLETED AND STORED (Column G on Continuation Page) 5. RETAINAGE: a. of Completed Work (Columns D + E on Continuation Page) b. of Material Stored (Column F on Continuation Page) Total Retainage (Line Be + 5b or Column 1 on Continuation Page) 6. TOTAL COMPLETED AND STORED LESS RETAINAGE (Line 4 minus Line 5 Total) 7. LESS PREVIOUS PAYMENT APPLICATIONS 8. PAYMENT DUE 9. BALANCE TO COMPLETION (Line 3 minus Line 6) $14,058.71 $240.650.00 $15,824.00 $256,474.00 $255,174.00 Contractor's signature below is his assurance to Owner, concerning the payment herein applied for, that: (1) the Work has been performed as required in the Contract Documents, (2) all sums previously paid to Contractor under the Contract have been used to pay Contractor's costs for labor, materials and other obligations under the Contract for Work previously paid for, and (3) Contractor is legally entitled to this payment. CONTRACTOR: Airflow Air Conditioning, Refrigeration & Heating By: �.�/%� /,/Q� 1/}i il� _ ,/.rte Date: ig State of: County of - Subscribed and sworn to before me this day of Notary Public: My Commission Expires: C JC�_oHIN D, TOiTr: StWe of New Yor;, #Q1 roos4�� --ntssjort iJ $12,756.71 ARCHITECT'S CERTIFICATION $242,415.29 Architect's signature below is his assurance to Owner, concerning the payment herein applied for, that: (1) Architect has Inspected the Work represented by this Application, (2) such Work has been $186,324.44 completed to the extent Indicated in this Application, and the quarity of workmanship and materials conforms with the Contract Documents, (3) this Application for Payment accurately states the amount of Work completed and payment due therefor, and (4) Architect knows of no reason why payment E56.090.a5 I should not be made. SUMMARY OF CHANGE ORDERS ADDITIONS DEDUCTIONS Total changes approved in previous months $3,208.50 $0.00 Total approved this month $12,615.50 $0.00 TOTALS $15,824.00 $0.00 NETCHANGES1 $15,824.00 0 d CERTIFIED AMOUNT......................................................................................... .! D9D• o� (If the cerUfied amount is different from the payment due, you should attach an explanation. initial all the figures that are changed to match the certified amount.) R G y By: Date: Neither thi Application nor payfke appliedrein is assignable or negotiable. aymenf shall be made only to Contractdr, and Is out prejudi to any rights of Owner or Contractor under the Contract Documents or otherwise. PAYMENT APPLICATION Quantum Software Solutions, Inc. Document CONTINUATION PAGE Page 2 of 3 PROJECT: Town of Wappinger APPLICATION #: 4 Highway Garage HVAC Improvements,Firewali DATE OF APPLICATION: 02/01/2010 Payment Application containing Contractors signature is attached. Construction & Electrical Remediation PERIOD THRU: 01/29/2010 PROJECT #s: 09-005 A B C D E F G. H i COMPLETED WORK STORED TOTAL % BALANCE ITEM # WORK DESCRIPTION SCHEDULED AMOUNT MATERIALS COMPLETED AND COMP. TO RETAINAGE (if Variable) AMOUNT AMOUNT PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G / C) COMPLETION PERIODS (D + E + F) (C -G) 1 Bid, performance and material $7,000.00 $7,000.00 $0.00 $0.00 $7,000.00 1000/a $0.00 $350.00 bonds 2 Mobilization - submittals $1,000.00 $1,000.00 $0.00 $0.00 $1,000.00 100% $0.00 $50.00 3 Reznor Furnace Products -Material $37,000.00 $0.00 $0.00 $37,000.00 $37,000.00 100% $0.00 $1,850.00 4 Bldg #1 - Firewall demo $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100% $0.00 $250.00 5 Bldg #1 -Firewall rough frame,cmu $22,000.00 $22,000.00 $0.00 $0.00 $22,000.00 100% $0.00 $1,100.00 block infilis & electric 6 Bldg #1 - Firewall insulation/drywall $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100% $0.00 $500.00 7 Bldg #1 - Firewall vinyl siding $7,945.00 $7,945.00 $0.00 $0.00 $7,945.00 100% $0.00 $397.25 8 Electrical remediation $21,000.00 $20,500.00 $500.00 $0.00 $21,000.00 100% $0.00 $1,050.00 9 Bldg #1 - Electrical support HVAC $4,500.00 $4,000.00 $500.00 $0.00 $4,500.00 100% $0.00 $225.00 10 Bks #2 - Electrical support HVAC $6,500.00 $6,000.00 $500.00 $0.00 $6,500.00 100% $0.00 $325.00 11 Bldg #1 & 2 - Natural gas piping $14,000.00 $12,200.00 $1,800.00 $0.00 $14,000.00 100% $0.00 $700.00 12 Bldg 92 -Install radiant heater #1 $5,500.00 $5,500.00 $0.00 $0.00 $5,500.00 100% $0.00 $275.00 13 Bldg #2 - Install furnace & duct $8,500.00 $8,500.00 $0.00 $0.00 $8,500.00 100% $0.00 $425.00 system AHU#1 14 Bldg #2 - Install furnace & duct $19,600.00 $19,600.00 $0.00 $0.00 $19,600.00 1009'0 $0.00 $980.00 system AHU#2 15 Bldg #2 - Install pipe bollards $5,100.00 $0.00 $5,100.00 $0.00 $5,100.00 100% $0.00 $255.00 16 Bldg #2 - Install exhaust $5,725.00 $2,862.50 $2,862.50 $0.00 $5,725.00 100% $0.00 $286.25 EF1,EF2,CF1 & CF2 SUB -TOTALS $180,370.00 $132,107.50 $11,262.50 $37,000.00 $180,370.00 100% $0.00 $9,018.50 CONTINUATION PAGE Quantum Software Solutions, Inc. Document CONTINUATION PAGE Page 3 of 3 PROJECT: Town of Wappinger APPLICATION #: 4 Highway Garage HVAC Improvements,Firewall DATE OF APPLICATION: 02/01/2010 Payment Application containing Contractor's signature is attached. Construction & Electrical Remediation PERIOD THRU: 01/29/2010 PROJECT #s: 09-005 A B C D E F G H I SCHEDULED COMPLETED WORK STORED TOTAL % BALANCE AMOUNT AMOUNT ITEM # WORK DESCRIPTION AMOUNT MATERIALS COMPLETED AND COMP, TO RETAINAGE PREVIOUS THIS PERIOD (NOT IN D OR E) STOREDIf (G / C) COMPLETION ( Variable) PERIODS (D + E + F) (C -G) 17 Bldg #1 - Install furnace & duct $18,440.00 $9,220.00 $9,220.00 $0.00 $18,440.00 100% $0.00 $922.00 system AHU#4 18 Bldg #1 - Install Furnace & duct $12,980.00 $3,245.00 $9,735.00 $0.00 $12,980.00 100`Y° $0.00 $649.00 system AHU#3 19 Bldg #1 - Exhaust EF3 in wall $3,860.00 $0.00 $3,860.00 $0.00 $3,860.00 100% $0.00 $193.00 20 Bldg 91 - Exhaust & duct system $18,850.00 $9,425.00 $9,425.00 $0.00 $18,850.00 100% $0.00 $942.50 EF4In attic 21 Bldg #1 - Construct furnace room wall, cmu - blockwall fillins $3,850.00 $1,925.00 $1,425.00 $0.00 $3,350.00 87% $500.00 $167.50 22 Bldg #2 - Startup, test, adjust & balance $750.00 $0.00 $750.00 $0.00 $750.00 100% $0.00 $37.50 23 Bldg #1 - Startup, test, adjust & $750.00 $0.00 $750.00 $0.00 $750.00 100% $0.00 $37.50 balance 24 Complete punch list items $500.00 $0.00 $0.00 $0.00 $0.00 0% $500.00 $0.00 25 Complete closeout submittals $300.00 $0.00 $0.00 $0.00 $0.00 0% $300.00 $0.00 26 Town of Wappinger Highway $3,208.50 $3,208.50 $0.00 $0,00 $3,208.50 100% $0.00 $160.43 Garage 27 Change Order # 2 Roof repairs $12,615.50 $0.00 $12,615.50 $0.00 $12,615.50 100% $0.00 $630.78 TOTALS $256,474.00 $159,131.00 $59,043.00 $37,000.00 $255,174.00 99°k $1,300.00 $12,758.71 CONTINUATION PAGE Quantum Software Solutions, Inc. Document Date 2` to O t i dt a (> Yxoopw lc Se, - (Name of Signatory Party) (Title) do hereby state: (1) That i pay or supervise the payment of the persons employed by AWPLOW AW foiyb 7on IA4G-j?E��etG>E,CAT�o�y+Ht7�t �«,I /� (Contractor or Subcontractor) Keir % rills i/19&#* aw—e— P4411%11 ; that during the payroll period commencing on the (Buildik or W ) day of tT4r1 NY1Y . *_W 10 . and ending the day of Tart dw o all persons employed on sold 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 AMPLD W A !12 wD, //{/C from the fun (Contractor or Subcontractor) 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 C.F.R. Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Start. 108, 72 Stat. 987; 76 StaL 357; 40 U.S.C. § 3145), and described below: (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 then 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 We 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 recogntned agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) BINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS 7n 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. (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 fess than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as fisted in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) ( EXPLANATION I NAME AND TITLE cane" 1•}tTf Ct)t'pf;�l9 S2Cft=.etary iafy THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR To CIVIL OR CRIMeJAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE U.S. Department of Labor PAYROLL Employment Standards Administration (For Contractor's Optionor! Use; See Instructions at www.dol.gov/e sa/whdlforrns/wh347instr.htm) U.S. W a«: Flour Division Wage and Hour Division� Persons are not required to respond to the crollection of imbrma6on unless it displays a currently varld OMB ccriw number. Rev. Dec. 2008 NAME OF CONTRACTOR m OR SUBCONTRACTOR [] ADDRESS P.O. Box 941 OMB No.: 1215-0149 Airflow Air Conditioning, Refrigeration & Heating, Inc. Highland, NY 12528 Expires: 12/31t2011 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT No. 01/05/2010 Town of Wappinger - Highway Garage HVAC Improvements. Fire wall Const & Elect. Ramp-diat)nn 0"05 (1) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g.. LAST FOUR DIGITS OF SOCIAL SECURITY� NUMBER) OF WORKER (2) a i 3 (3) WORK CLASSIFICATION (4)DAY AND DATE (5) TOTAL HOURS (9) RATE OF PAY (7) GROSS AMOUNT EARNED (sl DEDUCTIONS (g) NET WAGES PAID FOR WEEK W o ' 't"0 O I Th I 'b" Fr I S. 1/1 1/2 Su ]/3 M 1/4 fu t/5 FICA W �' HOLDING TAX OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Aaron Armbruster /)= - xx - 2886 343 Binnewater Rd Kingston, NY 12401 Sheet Metal Worker 1st year Apprentice o s 4.00 1m 11.00 $15.05 $165.55 $165.55 Aaron Armbruster / xxx - xx - 2886 343 Binnewater Rd Kingston, NY 12401 Sheet Metal Worker 2nd year Apprentice o s 030 400 10.50 $16.1$ $169.58 $169.58 Stephen Forgacs / xxx - xx - 4256 24 Doyle Drive Wappingers Falls, NY 12590 Sheet Metal Worker Journeyman o $826.08 $826.08 Is 030 7.00 a.00 530 24.00 $34.42 0 s 0 s 0 s 0 s 0 F TT While completion of Form WH -347 is optional, it is mandatory for covered contractors and subeontre otom pedorming work on Federally Manned or assisted eonstrucHon contracts to respond to the Information coladion contained in 29 C.F.R. §¢ 33, 5.5(s). The Copeland Ad (40 U.S.C. 9 3145) contractors and subcontractors performing work on Federally financed or misted construction contracts to'fumish weekly a statement with respect to the wages paid each employee during the pnsceding week' U.S. Department of labor (DOL) regulations at 29 C.F.R. § 5.5(e)(3x$) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the wnsW ction project, accompanied by a signed "Statement of CompNance' Indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not lees than the proper DAvvk-Sswn prwming wage rate for the work per(omted. DOL and federal contracting agencies receiving this Information review the Information to determine thatemployees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is wit take an average of 55 mbwtas to complete this collection, Including time for revlewkg Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and revlewing the collection of information. If you have any commends regarding acorea estimates or any other aspect of rids coeedion. Including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, FSA, U.S. Department of Labor, Room 53502, 200 Constitution Avenue, N.W. Washington, Q.C. 20210 (over) PAYROLL JOURNAL non oun-MOT MlowAir-Conditiorift NAME HOURS, EARNINGS, REIMBURSEMENTS & OTHER PAYMENTS VATHHOLDINGS DEDUCTIONS NET PAY RYIPLOYEE ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER PAYMENTS 100 OFFICERS M:00 Social Securfty 4(Y,3( I Direct Deposit # 1064 )urkin, Candice Regular Medicare 9:tC Chock Amt 0!00 Fed Income Tax 471 i Chkg 8743 525:913 I NY Income Tax 271 1 NY Disability 0-6( EMPLOYEE TOTAL? Regular 34j42UU Union Vacation 3110000 32100 650:10C 1,101-;4A 960 124:181 1 Social Security 7WI71 Medicare 18j4, Union Vaca 96:100 Work Asmnt 7V,32 525h3 Net P ay I Direct Deposit # 1065 Chock Amt OSIOO Durkin, -John ;2600 Work Assess 2: i 720A Fed Income Tax 14014( Chkg 4147 79374 Craft Tm-Memo 113400 U4238E NY Income Tax 69 NY Disability 0: 61 Health Fu -Memo 8i2600 M264132 M -Memo 011800 1115.7f M14.4( Industry -Memo 0:4500 M33,:21 Labor Mng-Memo 1:0400 I 815400 M273-21 National -Memo Profit Sh-Mento 41250 111413620C EMPLOYEE TOTA12 3200 : 1 1,269:,7 33071714W Net Pa793174 y 200 ADMINISTRATION 3573,00 Social Security 2211 : Enrect usposit # 1066 Kovalsky, Cindylou Regular 17:0000 :0 21: 0 Medicare Check Amt 0:00 19 31: Fed Inwme Tax 8 1 Chkg 0160 287185 NY Income Tax 913 NY n 0. NY Disability .6 EMPLOYEE TOTAL] 21j00 357*,0C Net Pay 287185. 300 SERVICE INSTALL 1kT1ON I i 5'. I Social Security 4'..91 Work S3C Direct Deposit# 1067 Armbruster, Aaron 0 Regular 10 5w .0 .75.2,- 513( Medicare Check Amt obo 11 Work Assess Disability 0. Chkg 7901 68169NY CHECK I TOTAL! 0 615E -- ---------------------- V3C '69 NetPay68: ------------- hQQC5Medicare --------------------- -----•----1-- Regular 16,05oo .0 11100 ---------------- 16515 ------------ -- ---------------------- Social Security 10�E 2; Direct Deposit 1068 Check Arnt 0100 Fed Income Tax 4:9 Chkg 7901 146.71 NY Income Tax 132 CHECK 2 TOTAQ jj: 165i -- ------------ -- 188 --------------- ------� -------- - Not P�y 171 -----........... 116t .......... Security 5`9 Work Asmnt 6--,3 Direct Deposit# 1069 0023 0023-01107 Airflow AIr-00CWd1fl0MI"9 Run Date 01106110 11:54AM Period Start - End Date 12130M - 01/05110 Check Date 01/08110 payml Journal Page I of 5 (3%,"N PAYROLL JOURNAL 0023 0023.0107 Airflow Alt-CondNioning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS & OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS ID DESCRIPTION RATE I HOURS I EARNINGS REIMS & OTHER PAYMENTS NET PAY ALLOCATIONS **** 300 SERVICE INSTAL TION (cant.) }� L� Regular 16:1500 5 8868 ? Medicare 113 Check Amt 0:00 I�lilhL711A �� Work Assess 161500; 8:33 i NY Disability 0j46 Chkg 7901 81107 i Craft Trn-Memo 0000 ; i M143 Health Fu -Memo 6:9900 i M3814 ITI-Memo 0:0100 M00 i Industry -Memo 01300 M0 7 1 National -Memo 1;8200 i M70<0 Profit Sh-Memo 1:2200 CHECK 3 TOTAL 5150 951 16 : 7:7 6i Net Pay 81:07 ---------------------' -----+- ----------' --------------- _ - --------------------- - -----------------------r- ------ '-------------r-.. I1I,sarr yp� ..� Regular 1611500 Work Assess IM50 169:156 1071 Social Security 11;1 Medicare 2:61 Work Asmnt 10, 71 Direct Deposit# 1070 Check Amt 0:00 Fed Income Tax 63 Chkg 7901 14755 NY Income Tax 1;8 ------ CHECK 4TOTAl ------f--- --- 105 -- 18012 -- --- -- ; -----------z- ------------------- 22:0- - ----- 10:71 - - --- --- -------------------------------------- Net Pay---- 147:55 ---------------- -- EMPLOYEE TOTAL, EMPLOYEE 320 52115 5511 22;3 Net Pa 444:02 Cruz, Willie Regular 2015800 321 85815 Social Security 4315 Work Asmnt 4315 Readychex # 110000296^2 29 Work Assess 1:3600 43;5 : Medicare 10:1 Check Amt 518:33 2 Craft Tm-Memo Health Fu -Memo ITI-Memo Industry -Memo Labor Mng-Memo National -Memo Profit Sh-Memo SASMI-Memo EMPLOYEE TOT Regular Union Vacation Work Assess Bldng Fun -Memo Craft Tm-Memo Health Fu -Memo ITI-Memo Industry -Memo National -Memo Profit Sh-Memo 0 0 1 L4 . 7:25C 1;750 11920 Fed Income Tax NY Income Tax NY Disability Medicare Fed Income Tax NY Income Tax NY Disability 1 4314 Net Pay Union Vaca Bi7q Readychex : Work Asmnt 91601 Check Amt 518133 296 119117 0023 0023-0107 Airflow Alr-CondHioning Payroll Journal Run Date 01!08/10 11:54AM Perlod Start - End Date 12130/09- 01/05/10 Page 2 of 5 Check Date 01/08110 PYRJRN PAYROLL JOURNAL 0023 00?3-0107 Airflow Alr•Cor:ditlontr:g RSEMENTS B OTHER PAYMENTS NATHHOLDIN6S I DEDUCTIONS EMPLOYEE NAME HOURS, EARNINGS, REIMBU O'Llvv -- -----18:3_ ----------------------- 81 = Medicare ID DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER Fed Income Tax NY Income Tax Bldng Fun -Memo Tm-Memo 0:6700 `• PAYMENTS NY Disability * * * * 300 SERVICE INSTAL TION (cont.) 1 9610 3 Work Asmnt 72::34 CHECK 1 TOTAL----- --------------------- }- - 50- 15416C -------------^- ' ------------i-- --------------------- 3 Regular 34142 27:0 929;3 ; Social Security Union Vacation CHECK I TOTAL 811 M273i2 M236o 11 36meo11 Medicare Income Tax 1 ---- ---------------- Work Assess ; ' 61,0 - Regular 32,:400C - 18:0 Fed i ' i Union Adm Union Vaca NY Income Tax Union Admin 1;0000 EMPLOYEE TOTAL'; 3 = 1,26917 , 35B CHECK 2 TOTAL.,07 ------------------ -•-►--- - 113 3 Forgacs, Stephen A Regular 34i9/-Uu Union Vacation 3-0000 O'Llvv -- -----18:3_ ----------------------- 81 = Medicare 25 �5 Work Assess 2;2600 Oi6700 , 3 72:3 M2114 Fed Income Tax NY Income Tax Bldng Fun -Memo Tm-Memo 0:6700 `• M21 ` M326;4 NY Disability 9QrsCraft a� Health Fu -Memo 1012000 0,1180Mi4j4 Union Veca 9610 Readychex # 110000296 Work Asmnt 72::34 IT[ -Memo 01450 201 3 Industry -Memo Labor Mng-Memo 1;0400 M3312 016 National -Memo 8:5400 412500 CHECK I TOTAL 1fi M273i2 M236o 11 36meo11 ------------;• ---- ---------------- Profit Sh-Mem SASMI-Memo 1!8800 ---------- - Regular 32,:400C - 18:0 ..----- 51814 Social Security Medicare i i Union Adm Union Vaca Union Admin 1;0000 EMPLOYEE TOTAL'; i 3Aci = 1,26917 Fed Income Tax 35B Union Vacation 213800 212000 Security NET PAY ALLOCATIONS Harding, Thomas a EMPLOYEE TOTAL Nei Pay -- -----18:3_ ----------------------- 81 -----------118:17 ------- - }E--- Readychex # 1100002964 Union Vaca Work Asmnt 61i02 Check Amt 613;97 Unbn Adm Union Vaca Patton, Robert Regular 31'14000 16;0 5021 12:8 i Union Admin i Net P97 - ----------_6----- 3217 18D.31 Net Pay 733:14 Union Veca 9610 Readychex # 110000296 Work Asmnt 72::34 Check Amt 806358 Harding, Thomas a EMPLOYEE TOTAL ' ' 3 391 = 1,26410 i , 1 Medicare Fed Income Tax NY Income Tax NY Disability Social Security Medicare 7t3i3 2074 731 08 378:21 34;1 810 Unbn Adm Union Vaca Patton, Robert Regular 31'14000 16;0 5021 12:8 5 Union Admin i 3633 Fed Income Tax 3217 Union Vacation s i NY Income Tax 201 3 NY Disability 016 CHECK I TOTAL 1fi 551 i5 ------------;• ---- ---------------- 95'B- ---------- - Regular 32,:400C - 18:0 ..----- 51814 Social Security Medicare 3514 813 Union Adm Union Vaca Union Admin 1;0000 16:0 38108 Fed Income Tax 35B Union Vacation 213800 212000 M35i2 NY Income Tax 21 it Annuity. -Memo 0023002'3-0407 AirrbwAir-Conditioning Period Start - End Date 12130J09-01!05!10 Run Date of/06/10 11:54AM Check Date 01/08f10 Check Amt O;uu Chkg 4209 872%1 1311 Net Pay 12i8 Direct Depo 3613 Check Amt i Savg 0226 4411 Net Pa 40635tS 1610 Direct Deposit # 1073 3830 Check Amt 0;00 Savg 0226 416241 Payroll JoumHI Page 3 of 6 PYRJRN PAYROLL JOURNAL 0023 0023.0107 Aktbw Air-Conditning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS 8, OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS NET PAY ID ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER PAYMENTS *� ** 300 SERVICE INSTAL TION (cont.) t H 5 W -Memo 6:6000 M105e6 NY Disability 06 HRA -Memo 14000 114221 Industry -Memo 010500 M01 InYI Tra-Memo 01000 M11 t Local Pen -Memo 4:1000 M65, ' National -Memo 0;7300 '1 Mi 1:6 Union Ed -Memo 0!5500 ? i MO CHECK 2TQTAI--------- ------------------- __-_ __ _ 572;48 101;9 54� NetPeY 416;41 Holiday 32;40 8 259:120 Social Security 16:0 Direct Deposit # 1074 Medicare 37 Check Amt 0100 NY Income Tax 4;6 r Savg 0226 234175 t CHECK --------------------- 3TOTAL _-_8;0_ --253-2- t ------------- -- ___-__-_______-______ Net Pay EMPLOYEE TOTAL! 40:;oc 1138312 22212f 103i2G Net Pay 1,057'174 Uphoff, Michael J Regular 24:'0500 2410 577;,2(Social Security 4112 Union Vaca 42:100 Direct Deposit # 1075 2$ Union Vacation 117500 4210 -3 Medicare 916 Work Asmnt 46-308 Check Amt 0100 Work Assess 1:9200 4610f Fed Income Tax 5710 Chkg 2938 442151 Bldng Fun -Memo 0:2000 M4e8 NY Income Tax 26111 Craft Tm-Memo 0;2200 ! M512 NY Disability 6,60 Health Fu -Memo 812600 i M1982 ITI-Memo 0:0200 Industry -Memo 012100 Moe M5,0 = Profit Sh-Memo 4'0300 M9617 1 t = EMPLOYEE TOTAL 24!0 665:2 134"6E 8810f Net Pay 442151 COMPANY TOTALS 10 Person(s) Regular 1 276::Sc 8,295:12A Social Security 57711 Health Ins 13'if Check Amt 2,05705 16 Transactron(s) Union Admin 2818 Medicare 13419 Union Adm 288 Dir Dep 4,423:60 Union Vacation 398;1 Fed Income Tax 930;2e Union Vaca 398;1 Work Assess e 1 327j20 NY Income Tax 411;38 Work Asmnt 327:2 Holiday ; 810C 259120 NY Disability 6*88 Annuity. -Memo 351 Bldng Fun -Memo 272 Craft Tm-Memo ' 976 H & W -Memo 105;6 NRA -Memo 221 Health Fu -Memo 1,168::Ss ITI-Memo 179 Industry -Memo 46:0 0023 0023-G107 Airflow Air -Conditioning Payroll Joumal Run Dale 01!06110 11:64AM Period Start - End Date 12/30/09 - 01/05110 Page 4 or 5 Check Date 01/08/10 PYRJRN PAYROLL JOURNAL 00230023-0107 A"ow Alr-Condidoning HOURS, EARNINOSy REIMBURSEMENTS & OTHER PAYMENTS WITHHOLDINGS EMPLOYEE NAME YMI ID DESCRIPTION RATE HOURS EARNINGS R pTSOTHER Infl Tra-Memo Labor Mng-Memo Local Pen -Memo National -Memo Profit Sh-Memo SASMI-Memo Union Ed -Memo COMPANY EmployerUelbffftes Social Security 577; Medicare 1' Fed Unemploy 74, NY Unemploy 568 NY Re-empl Svc 6 NY MCTMT TD 27 TOTAL OL E11PYER LIABILITY TOT TAX LIABILITY 3,470 DEDUCTIONS NET PAY ALLOCATIONS Vet Pay { i ' PayrollJoumal Page 5 of 5 00230023-6107 A"owAir-Condidonin9 Period Start - End Date 1 213 010 9-01 /0 511 0 PYRJRN Run Date 01/06110 11:54AM Check Date 01/0Hl10 U.S. Department of Labor PAYROLL WHO Employment Standards Administration (For Contractor's Optional Use; See Instructions at www.doi.gov/esa/whdlforrns/wh347instr.htm) Wage and Hour Division U.S. Ware and Hour Division Persons are not required to respond to the collection of information unless ft displays a currently valid OMB control numbs, Rea, Dec. 2008 NAME OF CONTRACTOR m OR SUBCONTRACTOR [] ADDRESS P.O. Box 941 Airflow Air Conditioning, Refrigeration &Heating, Inc Highland, NY 12528 OMB No.: 1215-014 Expires: 12/3112011 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 01/1212010 Town of Wappinger - Highway Garage Weer, 1 ..... Cn� ULu n n4 nns tt) NAME AND INDIVIDUAL IDENTIFYING NUMBERIK (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY€Ly NUMBER OF WORKER Aaron Armbruster / xxx - xx - 2886 343 Binnewater Rd Kingston, NY 12401 t2) o 9 3O (3) WORK CLASSIFICATION Sheet Metal Worker 2nd year Apprentice (4) DAY AND DATE ....'"•_•_••••,•••••r (6) TOTAL HOURS (6) RATE OF PAY , ,, •• --I (7) 13 AMOUNT EARNED $500.65 cora. a ua�u. RBR1CUIaIIO DEDUCTIONS tg) NET WAGES PAID FOR WEEK $500.65 6 VP 1/6 Th 117 Fr S. 1/8 119 Su VIo M int I112 FICA HOLROSSDING TAX OTHER TOTAL DEDUCTIONS D HOURS WORKED EACH DAY s 6.16 6.00 &00 6.50 5.ss 31.00 $16.15 Stephen Forgacs / xxx - xx - 4256 24 Doyle Drive Wappingers Falls, NY 12590 Sheet Metal Worker Journeyman o s clb &so &oro too aeo 40.00 $34,12 $1,376.80 $1,376.80 0 s 0 s 0 s 0 s 0 s Antga mmdatinn of r—, Wt.LaA7 k� a I. 0 S -- - - - - r-. ...^•ro ^�,^ �„ , a �,a r ,,,ro vtv u az;*i.I a uvrrscrucnon cvnuaps I0respond ro the nromlabon colWan contained In 2g C.F.R. §§ 3.3, 5.5(a). The Copeland Act (40 U.S.C. § 3145) tontraclore and subcontractors parforming work on Fedaregy financed or assisted comtrucilon contracts to'fumish weekly a statement with respect 10 the wages pail each employee doing the preceding week.' U.S. Department of Labor (DOLat 29 C.F.R. § 6.6(a)(3)(Ip repairs conuactore ) regutaO t to submit wacky, a copy of all payrolls to the Federal agency contracting for or rmancing the construction project, accomparied by a signed "Statement of Compifance" Indicating that the poyrdls are correct and complete and that each taborer or mechanic hes been paid not less Orn the proper Davis -Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this Information review the IMormatlon to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that Is wlq take an average of 65 minwtes to complete this collection, including Oma for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and omVleti g and reviewing the collection of Irdormatfon, if you have any comments regarding these estknetes or any other aspect of this collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, FBA, U.S. Department of Labor, Room S3502, 200 CmcsRution Avenue, N.W. WasNnglon. O.C. 20210 (over) PAYROLL JOURNAL 0023 0023.0107 Airflow Air-Conditkming EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENT'S &OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS ALIO'TPAY CATIONS REIMS & OTHER ID DESCRIPTION RATE HOURS EARNINGS PAYMENTS 100 OFFICERS= `• s 65010 i ; Social Security 40;3 ` ¢ Direct Deposit # 1076 0' 0100! Durkin, Candice Regulard , ; Medicare g•'tq Check Amt 525;13 Fed Income Tax 47!5 Chkg 8743 i } NY Income Tax 271 I NY Disability 016 i 12418 `• Net Pay 525,13 EMPLOYEE TOTAL i 65010 ? Social Security 9814 Union Vaca 120; 900 Direct Deposes # 1077 Check Amt 000 R 3414200 40; 1,376;8 Durkin, John e9 ular Union Vacation 3;0000 120; Medicare 23;01 Work Asmnt 201;1 Chkg 4147 962 41 4 Work Assess 22600 ? 9014 ; M536 Fed Income Tex NY Income Tax 9112 Craft Tm-Memo 1.340D M3301 NY Disability 0:6 Health Fu Memo 812600 i M712 IlI-Memo Industry -Memo 011800 0:4500 M181 06 1 Labor Mng-Memo 1.04 81540 M411 M34116C National -Memo Profit Sh-Memo 4;2500 M17010 EMPLOYEE TOTAL' 400 1,58712 Social Security 41413 f ' 34'7 2101 Net Pay 96241 Direct Deposit # 1078 Amt 0 00 *" "* 200 ADMINISTRATION 1 ` •. 33`1kl 561j Kovalsky, Cindylou Regular e9 17?0000 ? Medicare 801 Check Chkg 0160 433.39 19 i Fed Income Tax 62;4 NY income Tax 21'81 NY Disability 0'6 1 i s 1 ? 12716 ? Net Pay 433139 EMPLOYEE TOTAL; 330 i 300 SERVICE INSTALL ILTION ? ' 1 910 ? 145?3 ' ' Social Security 2416 Work AsmM 21'2 Deposit 1 Direct De sit # 1079 Amt 00 Armbruster, Aaron D Regular 1615 111500 1 2112 ' Medicare 517 ; Check Chkg 7901 295116 11 Work Assess Overtime 24;2250 9! 23011 1 ! M416 Fed Income Tax NY Income Tax 3718 1115 ; Craft TnrMemo 0'2500 i M12913 NY Disability 0'6 Health Fu -Memo 6'990 ` M: ITI-Memo 0;010 M2214 i industry -Memo 0;1300 i M3316 National -Memo 11%8200 10200 M2235 Profit Sh-Memo 3961 i 8013 21-26Net Pay 295;16 CHECK 1 TOTAL; 180 i Payroll Joumal 0023 0023-6107 Aliflow Air-Condidoning Period -End Date 0111 0 - 01!12110 Page 1 of 4 pYRJRN Run Date 01!13!10 12:04 PM DateStar[ Check Date 511 01115!10 PAYROLL JOURNAL 00230023-0407 Airflow Air-Condidoning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS a OTHER PAYMENTS WITHHOLDINC,S DEDUCTIONS NET PAY DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER ID ALLOCATIONS PAYMENTS 1 ; 300 SERVICE INSTALL TION (cont.) Regular 181500 Work Assess 311,0C 500joc 31,8 Sochi Security 33;0 Medicare Work Asmnt3116 Direct Deposit # 1080 f1 : 71 Ped Income Tax sail 1 Check Amt a100 Chkg 7901 382111 = NY Income Tax 19: 1 1 1 : ------ CHECK 2 TOTAL] -------------------------- ---- 3110- ----- 532;2 - 1 --------- - 118; -------------------- 31:6 --------------------- ----------------------- Net Pay 382;11 --- EMPLOYEE TOTAL; 4t 929; 198:8 52i9O Net Pay 677;27 Cruz, Willie Regular 20,5800 36; 7821 Social Security 51:6 Work Asmnt 51168 Readychex# 1100002966 29 Work Assess 1;3600 5116 Medicare 12:0 Check Amt 802;97 Craft Tm-Memo 018000 M30` Fed Income Tax 75;0 : Health Fu Memo 913700 M356I NY Income Tax 3916 ITI-Memo 0:1800 : M61 NY Disability 01 Industry -Memo 0;3000 = M111 Labor Mng-Memo 0:6200 M23` National -Memo 5:1200 i M194E5 Profit Sh-Memo 1:1000 M41f SASMI-Memo 111300 : : M421 ? i EMPLOYEE TOTAL; 38'i0q 833172 179:0 51: Net Pay 602:97 Davies, Arthur Regular 272500 8!50 231:63 3 Social Security 43=91 Loan 281 Reedychex # 110000296 2 Union Vacation 1;7500 j 32j38 : Medicare 10127 Union Vace 32138 Check Amt 439360 Work Assess 139200 ! 35:5 : Fed income Tax 861 Work Asmnt 35:5 =. Overtime 40,8750 10i0a 408175 NY income Tax 3116 Hldng Fun -Memo 012000 1 j M3170 NY Disability 016 Craft TM -Memo 0F200 ! ! M41'0 1 Health Fu -Memo 8,2600 ! ! M152i`81 ITI-Memo 010200 : M013 Industry -Memo 0:2100 : ! M318 : 1 National -Memo 3;0400 m ; M56s2 Profit Sh-Meng 4,0300 1 M744 CHECK TO p�� CHECK 1 TOT•=F•- ---- 1Bi - 7D8:2 ---------- ---•-------------- 172:5 -- ---•-•--.....--•--•-9611 - -- - Net Pa -439:6.0- ----.Y.--- -- •---- Regular 3414200 • 31 _......._ --- 1,084; Social Security 7T: Union Vaca 943 ----- - Readychex# 110000296@ Union Vacation 1 94!50Medicare 1811 Work Asmnt 7111 Check Amt 698:32 Work Assess 7111 1 Fed Income Tax 22114 ! ' NY Income Tax 68:8 CHECK 2 TOTAL -. - - --- - ---- -- - -31:-- - 1,249:9 ------- 3 - ------------ 385:91 ---------- --- ------ -- 1656 ------------------------- Net Pay 698:32 ----- --- -- ---- ------ 0023 0023-0107 Airflow Alr•Corrdltloning Payroll Joumal Run Date 01113/10 12:04 PM Period Start - End Date 0`1/061110-01/12110 Page 2 or 4 Check Date 01/15/10 PYRJRN PAYROLL JOURNAL. :MPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENT$ & OTHER PAYMENTS VOTHHOLDINGS DEDUCTIONS NET FAY ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMS A OTHER D PAYMENTS *"* 300 SERVICE INSTALL TION (Conti) ' 50'0 1,958 i ' 558.4 261j8 Net Pay 9,137•.92 EMPLOYEE TOTAL! Regular 34}4200 40. 1,376: Social Security 98;4 Medicare 23;0 Union Vaca 4201 Readychex # 11000029 69 Work Asmrt 90 Check And 981 28 °orgacs, Stephen A I 1� Tht� _A, Union Vacation 3000 Work Assess 2;2600 } } 120'0 90'4 ' M26i8 Fed Income Tex 183; NY Income Tax 89;9 } Bidng Fun -Meme 0;8 ! ' M2618 NY Disability Oi Vr ` !;raft Tm-Memo 0i670 } M40Bi ` Health Fu -Memo 10'2000 i M7'2 ITI-Memo 00800 Industry -Memo 014600 ? ! M181 Labor Mng-Memo 1:04 8'540 ' M4ii M341' National -Memo ' M17010t Profit Sh-Memo 4:2500 1:8800 ' i M753 SASMI-Memo i EMPLOYEE TOTAL 401 1,5871207913 395:5 Social Security 210 Net Pa 981228 Health Ins 13;1 Direct Deposit 1081 '• Narding, Thomas Regular 32E0000 40' ` 1,28010 Medicare 181 Check Amt 0100 Chkg 4209 862!29 8 Fed Income Tax 211:4 i NY Income Tax 74' ! NY Disability 0 ` } 384? 1311 Net Pay 882129 EMPLOYEE TOTALS Regular 32:40 Union Admin 110000 401 275 It 1,284: 891:0 27' i Social Security 61:0 Medicare 1412 1 Tax 97;5 Union Adm 27; Direct Deposit# 1082 ; 65:4 Check Amt 0100 Union Vaca S9 0226 6672 : Patton, Robert 5 Union Vacation 43800 ' 65€ } M60-5 Fed income NY Income Tax 49j9 Annuity -Memo 2'200 6000 M18115C Disability Oi6 ! i H 8: W -Memo 14000 ! i M38i s t HRA -Memo 0i0 j M1'3 Industry -Memo M2i7 '• 0,1000! inYl Tra-Memoi 411000@ ! j M11227 ' } Local Pen -Memo M20' j } National -Memo 0:7300 i M151 Union Ed -Memo 6000 i ' t 92'9 Net Pay 667'62 EMPLOYEE TOTAL 27( 40 983:9 9621 B5i7 i Social Security 90 9 Medicare 21;2 Union Vaca 85;7 Direct DeposR # 1083 i Work Asmnt 9410 Check Amt 0100 Chkg 2938 863:71 Uphatt, Michael J Regular 24500 1;7 28 Union Vacation Assess 1 X920 i 94;0 ± ' Fed income Tax 2410 Work Overtime 36M760 9i 324: i i M9; NY Income Tax 81 i NY Disability 0:6 Bldlig Fun -Memo O:2000 01220 M10{7 Craft TM -Memo M404;7 Health Fu Memo 812600 M09 RI -Memo 0:0200 0023 0023.0107 Alrrtow Air-Conditning Period Start - End Date 01106/10 - 01112110 Run Date 011 13110 12:04PM Check Date 01/15110 ayroi} ►cumal Page 3 of 4 PYRJRN PAYROLL JOURNAL 0023 0023-6107 AirflowAir-Condrdoning EMPLOYEE NAME ID HOURS, EARNINGS, REIMBURSEMENTS & OTHER PAYMENTS MTHHOLDINGS DEDUCTIONS NET PAY ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REINIS & OTHER PAYMENTS 300 SERVICE INET 'LYON (coni.)t Industry -Memo 012100 M1029 Profit Sh-Memo 4,0300 M19r,47 Misc Reimb 11184 EMPLOYEE TOTAQ 49A 1,466,51j 1181 434,8 179;8 Not Pay 8631171 COMPANY TOTALS loperwh(s) Regular 33815C 9,841; = Social Security 8 73318 Health Ins 13:11 i Check 2,722-17 12 Transaction(s) Union Admin 2715( 1 Medicare 171-,6 Loan 281Z Dir Dep Union Vacation 518,10t Fed Income Tax 1,523:1 Union Adm 27:5( Work Assess 466: 1 NY Income Tax 606' .5 Union Vaca Overtime 28:50 NY Disability 6 Work Asmint 486`11, Annulty:Merno 601 BIdng Fun-MemoI 403 Craft Trn-Memo 13012 2 H & W -Memo HRA -Memo 38: Health Fu -Memo 1,781:3 i lit -Memo Industry -Memo 55i3 Int'l Tra-Memo 1 i 217 Labor Mng-Memo i i 1067 l Local Pen -Memo 1121:7 National -Memo 98717 Profit Sh-Memo -4 SASMI-Memo Union Ed -Memo Mise Reimb COMPANY TOTAQ. 3671OC 11,836:82 11:81 3,041:51 1,07311E Net Pay 7,733"99 Emp"rUebflffles Social Security 733:88 i Medicare 171::62 Fed Unemploy 9417 NY Unernploy 748le NY Re-empl Svc 8i8 NY MCTMT TI) 34:8 TOTAL EMP OYER LIABILITY 1,792:6 i TQTj J_ TAX LIABILITY 4,83411 0023 0023-61 07 Airflow Alr-Candidonlng Payroll Journal Run Date 01/13/10 1204 PM Period Start - End Date 01106!I0_01M2/10 Page 4 of 4 Check Date 01/15110 PYRJRW U.S. Department of Labor PAYROLL MHO Employment Standards Administration (For Contractor's Optional Use; See Instructions at www.dol.govlesa/whdMonns/Wh347instr.htm) U.S. Wage and Itow Division Wage and Hour Division persons are not required to respond to the C0119agn of Wwwhon w*ss it displays a currently varid OAQ eonhel number. Rev. Dec. 2008 NAME OF CONTRACTOR m OR SUBCONTRACTOR [] ADDRESS P.O. Box 941 OMB No.: 1215-0149 Airflow Air Conditioning, Refrigeration &Heating, Inc. Highland, NY 12528 Expires: 12131!2011 FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. PAYROLL too. Town of Wappinger - Highway Garage 01!19/2010 HVAC Imorovements, Fire Wag Const. 8r Electrical Remedi 09 005 (1) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g.. LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER OF WORKER Aaron Armbruster ! xxx - xx - 2886 343 Binnewater Rd Kingston, NY 12401 (2) 0 a � o gid z 3 (3) WORK CLASSIFICATION Sheet Metal Worker 2nd year Apprentice t' W c V13 HOURS o (4) DAY AND DATE (5) TOTAL HOURS (6T RATE OF PAY m GROSS AMOUNT EARNED 5436.05 (B) DEDUCTIONS (91 NET WAGES PAID FOR WEEK $436.05 Th t/t4 Fr V15 Sa V16 Su 1/11 M 1/111 Tu 1119 FICA WITH HOLDING TAX OTHER TOTAL DEDUCTIONS WORKED EACH DAY s 400 6.s0 4m &00 6so 27.00 $16.16 Sheet Metal Worker Journeyman o $1,049.81 $1,049.81 Stephen Forgacs / xxx - roc - 4256 24 Doyle Drive Wappingers Falls, NY 12590 s 6a0 5.00 sm Lee 6.50 30.50 534.42 Sheet Metal Worker Journeyman 0 s 6.,s s� 10.25 sm•42 5352.81 $352.81 Michael Uphoff / xxx - xx - 4108 55 Sands Ave. Milton, NY 12547 0 fi O fi O 5 O s D �.......ew.......n..w,,, —+.i ed to 29 C.F.R. 46 3.3.5.5(x). The CePetand Ad 5 White completion of Form WH -347 Is Optional. It Is mandatory for covered eontr odors and submntraemre Pertorming coons On reoarerry rnenceu o. neen.�...... N. -w-•• ^^ ^.--- -- -._ .... _.. - - - - - w, .. U.S. De r&*Trt of tabor (DOL) regutavons sal (40 U.S.C. § 3145) contractors and subcontredom perforndng worts on Federally fhanead or assisted conatru Won contracts to 'furnish we" a statement wllh roped to the wages pail aeeh employee during the preeeding Pa 29 C.F.R. § 5.5(ax9xR) reQuke contractors to wbm9 wacky a copy Of ell Parrots to the Federal age contracting for or financing the construction projeo4 accompanied by a signed 'Statement of Cgrfpnence' Mdicalxg that the payrons ere correct and compete a thaand t laborer or medmrtic he been paid not lase then distproper Davis -Bacon prevelling wage rate for the work performed. DOL and federal eontmoft agendas receiOng'this Information revleW the Irdonmatlon to datemmne that employee have received IngaiY required gas PuMk Braden Statement We estimate that is w9 fake an average 0155 minutes to complete this edleclicn. Including Ome for revlewkg Instructions, searching existing data sources, gathering and maintaintng the data needed, and completing and reviewing the colledlon of information If you have arty comments regaw l l t k can event a or arty other aspect or this collection, Inducing suggestions for redudng this burden, send them to the Administrator. Wage and Hour Division, ESA, U.S. Dapartment of Labor. Room SgSM 200 Constibdlon Avenue, N.W. Washington, D.C. 20210 PAYROLL JOURNAL 0023 0023.0107 AlfflowNt-Conditioning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS & OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS NET P" ID ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER PAYMENTS 100 OFFICERS Durkin, Candice Regular 1 850:00 Social Security 403,3( Direct Deposit 1084 Amt0;00 Medicare 914 i Check Fed Income Tax 47:15( Chkg 8743 525113 NY Income Tax 27-D, NY Disability 0.6( EMPLOYEE TOTAL; 65010q 1241871 Net Pay MSIS13 Durkin, John Regular 3414200 401oc 1,376180 1 Social Security 9814' Union Vaca 1201OC Direct Deposit # 1085 1 4 Union Vacation 3',D000 120`00 Medicare 2310' Work Asmnt 90:140 Check Amt 0`00Work Assess 22600 go.!40 Fed Income Tax 201!1 1 Chkg 4147 962141 Craft Trn-Memo 1;340 M5316C NY Income Tax 9112, NY 0,6( Health Fu -Memo 812600 M330i,4C Disability ITI-Memo 0;1800 M712C Industry -Memo 0.4' 6 w M18.01: Af41:& Labor Mng-Memo 110400 National -Memo 8:5400 M34116C Profit Sh-Memo 4' .2500 M17i7.0( EMPLOYEE TOTAL 40100 1,58712 41413� 2164C Net Pay 962j41 200 ADMINISTRATION Kovalsky, Clndylou Regular 17,10000 3310C 681 00 Social Security 3437f Direct Deposit# 1086 119Medicare Check Amt 0100 Fed Income Tax 621,41 Chkg 0160 433:39 NY Income Tax 2116' NY Disability 0:6( EMPLOYEE TOTAL.;330 4 561 00 12716 t NetPay 433:139 300 SERVICE INSTALL Armbruster, Aaroh D %TION Regular 16;1500 1310U zogim social security 13: 9 Loan 1411 Direct Deposit# 1087 11 Work Assess 1:1600 1 14:96 Medicare 30 14 Work Asmnt i95 Check Amt 00 Craft Tm-Memo 012500 M3-21:, Fed Income Tax 1201 Chkg 7901 162:.31 Health Fu -Memo 6;9900 M901 7 NY Income Tax 316: . ITI-Memo 010100 MoiV NY Disability 0161 Industry -Memo 0j1300 MI.,& I National -Memo 1j820 M23P Profit Sh-Memo 112200 Ml"( CHECK 1 ]IqT�L!; 13!00 224190 33. ------ .5 -------------- --- 29� ------------------------ 1!�y 162:31 . ............ ..... ---------------- ......... Regular 161`1500 Work Assess ------ '00 27' --------------- 436105 27�54 Social Security 2874 Medicare 6:72 Work Asmnt 27 Direct Deposit A 1088 Check Amt obo 0023 0023.rA07 Airflow Air -Conditioning Payroll Journal Run Date 01/20/10 10:19AM Period Start- End Date 01113/10- 01119/10 Page lof4 Check Date 01122110 PYRJRN PAYROLL JOURNAL 0023 0023.0107 Ak%w Air-Conditloning EMPLOYEE NAME ID HOURS, EARNINGS, REIMBURSEMENTS & OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS NET PAY ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMS & OTHER PAYMENTS * * * 300 SERVICE INSTALL TION (cent.) 1 Fed Income Tax 47:8 i Chk 7901 3375 9 NY Income Tax 1514 CHECK 2 TOTAL! _ -`-EMPLOYEE -- 2T'0 __•.-•--- 4631 - =98.8i ---------- - ---- -------------- - 271 -----------------------r- Net Pe 337125 Y --------------- TOTAL, 4060• 15j0 68814 408!7 i ! 432131 Social Security 28;7 5616 Union Vaca 26;2 Net Pay 499156 Readychex # 110000297Q Davies, Arthur Regular 27;2 Union Vacation 1;7500 2612 Medicare Q Work Asmni 28;8 Check Amt 309,28 2 Work Assess 1:9200 Fun 0;2000M31 28.8 Fed Income Tex 47191 NY income Tax 15:4 ' ' Bldng -Memo Craft Tm-Memo 0;220 M3.3 NY Disability NB ' Health Fu -Memo 812600 M123j9 ITl-Memo 0`•0200 MO! Industry -Memo 0:2100 M311 National -Memo 310400 M4516 Profit Sh-Memo 4103 M6014 i i CHECK 1 TOTAL'. 151 . 9914_ ----------------i------------------------------ 5510 Net Pay 309128 --------------- - -------•-------- ............4.6j:-- Social Security 61 Union Vaca 751 Readychex # 110000297 Regular 34' 200 ! 25'0 1 860: 7510 Medicare 141 Work Asmnt 56� Check Amt 576148 Union Vacation ! 561 Fed Income Tax 15701 i 1 Work Assess i NY income Tax 51:1 i CHECK 2TOTAL's-- 2. j-----------------------'0----------------------- - -- --------------131=_ NetPaY----------- -i --25' - -- ----------992;0-............ EMPLOYEE TOTAL 4010 1,4551 383;4 18fi15 Net Pay 885176 Forgacs, Stephen A : Regular 3414200 401 1,37618 1201 1 Social Security 98141 Medicare 23104 !inion Vaca 1201 Work Asmnt 9014 Readychex# 1100002972 Check Amt 981=28 2558 ,5 Union Vacation 3lDO Work Assess 21,2800 ; i 9014 1 1 M2618 Fed Income Tax 183E NY Income Tax 8919 Bldng Fun -Memo 06700 ! M26 NY Disability 01,6 Craft Tm-Memo 0:67 1012000 1 i 1 M408i 1 Health Fu -Memo Mri ITI-Memo ON800 i M18:•2 ' Industry -Memo 0?4500 = M413 ! 1, -M Labor Mngemo 110400 1 M3416 National -Memo 815400 4000 i M17010 Profit Sh-Memo M7512 SASMI-Memc 118500 i 1 EMPLOYEE T07AL' i 401 1 1,587i2 i i 39515 i 210:4 Net Pay 981:28 0023 0023.6107 Airflow AU-ConditlordN Run Date 01120!10 10:19 AM Period Start - End Date 01113110.01/19110 Check Date 01!22110 Payroll Journal Paga 2 of 4 MRN PAYROLL JOURNAL 0023 0023.0107 Alr low Mr-CondlNoning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS 8. OTHER PAYMENTS WITHHOLDINGS DEDUCTIONS NET PAY ID ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS REIMB & OTHER PAYMENTS * * * * 300 SERVICE INSTALL ATION (coat.) 5 Harding, Thomas Regular 32,0000 40[0C 1,280i '00 Social Security 83;8 Health Ins 13;1 Direct Deposit# 1069 `• 8 Overtime 48:0000 1: 7210 ' Medicare 1916 = Check Amt 0;00 i Fed Income Tax 22914 1 Chkg 4209 925186 ' NY Income Tax 7914 NY Disability 06 EMPLOYEE TOTAL 41: 1,352! 412: 13' HS Net Pay 925:86 Patton, Robert Regular 32:4000 401 1,2969DO Social Security 88! Union Adm 40,00 Direct Deposit # 1090 i 5 Union Admin 110000 40100 Medicare 20 '71 Union Vaca 9512 Check Amt 0100 Union Vacation 2138 ; 95-:20 Fed Income Tax 164,64 Savg 0226 940468 Annuity. -Memo 2;200 ! M881 NY Income Tax 80; H & W -Memo 0000 M264: NY Disability 0: HRA -Memo 1:4000 M56! Industry -Memo 0:0500 M210 Intl Tra-Memo 05100 M4;0 Local Pen -Memo 451000 M164: National -Memo 057300 M292 Union Ed -Memo 0,5500 5 : i M22 EMPLOYEE TOTAL•, 40 1,43152 35553 135�'20 Net Pay 940:68 Uphoff, Michael J Regular 2450600 29'75 715:4 Social Security 54}8 Unlon Vaca 54;6 Direct Deposit # 1091 28 Union Vacation 117 5 5446 Medicare 1258 Work Asmnt 605 Check Amt Oi00 Work Assess 1592 : 60;0 Fed Income Tax 94:9 Chkg 2938 565524 Overtime 3610750 1i 54;11 NY Income Tax 411 81dng Fun Memo 02000 ; M612 NY Dlsab6Ny 0: 5 Craft Tm-Memo 042200 4 i M618 ' _ '• Health Fu -Memo 812600 i M258!1 III -Memo 040200 : MOi6 5 Industry -Memo 02100 M6.5 I Profit Sit -Memo 4;0300 s M12559 I 1 TOTAL CHECK1 TOTAF- 88412 204 1 14•.6 Net 5fi 6F24 Pay-------------- -- ---------------------CHECK - ---- --,- f-- ---- - - -'--i-- _;-- ------------ ------- ------------- i - ----------------------- ----------------------- -- ��yy�� Regular 34 I 1012 352.81 30:75 5 Social Security 251Z Medicare :91 Union Vaca 3M75 Work Asmnt 23-17 Direct Deposit # 1092 '• Check Amt 0500 Union Vacation : Chkg 2938 293136 Work Assess i 2351 Fed Income Tax 181 NY 959 Income Tax } C------ TOTAL'• 10;:25 401317353 59 539 ---------------------- Net 29346 --- Pey-------------- -- --------- ---------- -- --------------! : EMPLOYEE TOTAL ! 41: 1,291:0 263;71 1686 Net Pay 858:70 0023 0023.6107 Airflow Alr-Conditioning Payroll Journal Run Date 01120/10 10:19 AM Period Start - End Date 01/13/10-01/19110 Page 3 of 4 Check Date 01122/10 PYRJRN PAYROLL JOURNAL 0023 0023-1107 Airflow Air-Candi*MWQ EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS S OTHER PAYMENTS YNTHHOLDINGS DEDUCTIONS NET PAY ALLOCATIONS DESCRIPTION RATE HOURS EARNINGS R91MB & OTHER 10 s PAYMENTS 3 • 313; 3 9,624,1 ! 1 Social Security � 6571 Health Ins i i 13;1 i Check Amt 1,867;04 COMPANY TOTALS 9 Persons) Regular 1 403 1 Medicare 153'7 Loan 1411 Ok Dep 5,14573 12 Transections) Union Admin 3 52158 = Fed Income Tax 1,267•,01 Union Adm 401 Union Vacation : NY Income Tax 626;5 Union Vaca 521;8 , W� Assess Overtime i 33 126'11 ? NY Disability 5.14 Work Asmnt 39137 Annuity. -Memo ' 1 ` 881 36'0 ' Bldng Fun -Memo ` 933 21 3 -Meo Craft Tm m 1 _ 26orLn H & W -Memo i Sfi210 1 HRA -Memo 21 Health Fu -Memo ' + 151 IT[ -Memo ` = 4914 Industry -Memo 421 1nt'I Tra-Memo 83:2 Labor Mng-Memo 11 Local Pen -Memo 3 781 216 1 National -Memo ' ' 5422 Profit Sh-Memo ' 75212 SASMI-Memo 2210 Union Ed -Memo COMPANY TOTAL; 316:11 10,603391 i 2,61011 ; 980:9 , Net Pay 7.01277 = i ' EnwbyerU8bNW6s i 3 3 Social Security 6573 Medicare 153:7 ' Fed Unemploy 8438 NY Unempioy 670j6 3 NY R"mpl Svc 719 NY MCTMT TD 3016 ' 1 TOTAL EMP OYER LIABILITY 1,60513 TOT L TAX LIABILITY 4,211 ] 3 3 : k i 1 i 0023 0023.0107 Alrflow Air -Conditioning Run Date 0112D110 10:19AM Period Start - End Date 01113110-01119110 Check Date Otf22110 Payroll Joumal Page 4 of 4 PYRJRN U.S. Department of Labor PAYROLL aIND Employment Standards Administration (For Contractor's optionai Use; See Instructions at www.dol.goviesa/whd/forms/wh347instr.htm) Wage and Hour Division persons are not fired tore U.S. Wage and Hour Division requ spond to the collection of Information unless it drsp/ays a currently valid OMB control number. Rev. Dec. 2008 NAME OF CONTRACTOR m OR SUBCONTRACTOR ADDRESS P.O. Box 941 OMB No.: 1215-0149 Airflow Air Conditioning, Refrigeration & Heating, Inc. Highland, NY 12528 Expires: 12/31/2011 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECTOR CONTRACT N0. 01/26/2010 Town of Wappinger- Highway Garage 09-006 HVAr: tmnrnvo— to Firo w.0 r--..# 9. cne o x u {t) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER OF WORKER (2) ,� O tsy: g38 (3) W ORK CLASSIFICATION (4) DAY AND DATE (5) TOTAL HOURS (6) RATE OF PAY (T) GROSS_ AMOUNT EARNED DEDUCTIONS (g) NET WAGES FOR WEEK In w o IR t2a Th int Fr 1122 Sa 1123 Su IR4 M IRS Tu I26 FICA HOLDING TAX OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Aaron Armbruster / xxx - xx - 2886 343 Binnewater Rd Kingston, NY 12401 Sheet Metal Worker 2nd year Apprentice o 1 $209.95 $209,95 a e.so ssa 13.00 stets Arthur Davies / xxx - xx - 2625 5691 Route 209 Kerhonkson, NY 12446 Sheet Metal Worker Journeyman o $378.62 $378.62 IS 6A 5.60 11.00 $34.41 Michael Uphoff / xxx - xx - 4108 55 Sands Ave Milton, NY 12547 Sheet Metal Worker Journeyman o $309.78 $309.78 s 1.50 3.90 1.509.00 934.42 0 s 0 s 0 s 0 s 0 s rnae wmprekwn or roan VV a 44r is opnonai, it is manderory mr covered connacwm and mboomrecWR Porro" work on Federally financed or assisted construction contracts to respond to the Information collection contained in 29 C.F.R. §§ 3.3, 5.5(a). The Copeland AG (40 U.S.C. § 3145) contractors and sutwontraclom parformIng work on Federally financed or assisted construction contracts M "fumish weel y a statement with respect to the wages paid each amp" during the preceding week' U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(a)[3xl0 require contractors to submit weekly a copy of as payrolls to the Federal agency contracting for or financing the constriction pro)ect, accdrnpanled by a signed "Statement of Compliance' Indicating that the payrolls are correct and complete and that each laborer or machank has been paid not less than the proper Davis -Beton prevailhng wage rate for the work performed. DOL and federal contracting agendas ieeelving this Infortnntlon review the kdornallon to determine that employees have received legally required wages and fringe benefris. Public Burden Statement We estimabs that is win take an average of 55 minutes to complete this collection, Including time for reviewkV Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding these astknates or any other aspect of this collection, Including suggestions for reducing this burden, send them to the Administrator, Wage and Hour DivisloL FSA, U.S. Departmentof labor, Room S350$ 200 Constitution Avenue, N.W. Washington, D.C. 20210 (over) PAYROLL JOURNAL 0023 (1023-0107 AirflowAir-Condidaning EMPLOYEE MAMIE HOURS, EARNINGS, RMMSURSEIMEMTS & 0714ER PAYMENTS VATHIJOLIMINGS DEDUCTION!; NET PAY ID ALLOCATION$ DESCRIPTION RAT11 HOURS EARNINGS REIMS & OTHER PAYMENTS 100 OFFICERS Durkin, Candies Regular' Social Security 40;3 Direict Deposit # 1093 1 Medicare 9:4 Chark Amt q�o Fed Income Tax 47:6 Chka 8743 525-I13 I NY Income 'fax 27' NY DIsablII4- EMPLOYEE TOTAL;, ;0: 6r;0I 12487 Not Pay &!413 Durkin, John Regular 34K200 40 DC 1,31'6 80 Social Security 98',41 Union Vaca 120'-,00 Direct Deposit 1094 4 Union Vacation 341)000 IG -1,00 Medicare 23101 Work Ammt 9010 Cho -.k AjTd 01:00 Work Assess 2`9600 voko ' Fed Income Tax 201113 Chkq 410.7 562:41 Craft Trn-Memo 1:3400 r U5316G NY Income "Fax 91!24 Health Fu -Memo 8:,.9600 M3.30:4 NY Disability 0160 ITI-Memo 0:1800 M712 n Industry Memo 01-1500 M181.10C LloorMng-Memo 1 i:0400 - Wfl'eC National -Memo8' MSf 14W Profit Sl- -Memo 419500 Mf 70.OG EMPLOYEE TOTAL, 401100 414'3C 210AC Not 1'� Rj2:41 200 ADWIMISTRATION Kovalvicy, Cindyh)u Regular 17.k1000 25:00 42.51.00 Social Security 2613,r Direct Deposit # 1095 19 Medicare 6*1( CheakAint 0,!00 Fed Income Tax 42:,0S Chkv 0160 -,36162 NY Income 'rax 1311E NY DlsabM4- 0216C EMPLOYEE TGTA4 26j00 425 OQ 8813f Not Pay 300 SERVICE 114STALL Ft;ION t Armbruster, Aaron D Regular 161:1600 810o Social Security 815( Wor< Asmnt 12C Direct Deposit 1096 ii Work Assess ilisoo :2C 9. 'Medicare 20 I Cheak Aint 0.00,0 Cnift Trr-Memo up:ouu A42100 Fed Income Tax 22 Chk[I 7901 1-15i:63 Health Fu -Memo 6iP900 U.55j92 NY Income Tax 0117 M -Memo 0.0100 Ajo. 08 NY Disability 0: C Industry -Memo 0:0300 : National -Memo 1;6200M14!56 Profit Sh-Memo Il -9200 'HECK I TOTAL ---------- ------------ --------------------- 13 ` -------------------- ........... 1-15.63 -------- Regular %11500 Work Assess ------ 3 15C ------------ 508:73 -:,2! 13 1 social Security 31.15 Medicate 7:8 Worlk Asmnt 3211 Direct Deposit# 1097 Chei-k Arnt 0:'00 0023 0023-61 07 A1010WAIr-Conditlonfrig Payrop Journal Run Dale 01/27/10 01:12PM Period Slarl - End Date OV20111(1-01/26M0 Pepe I of 4 Check Date 01=110 F,YRJRN PAYROLL JOURNAL. 0023 (1023439 07 Airflow Alt-Condidoning EMPLOYEE MAMIE HOURS, EARMING14 REIMBURSEMENTS & OTHER PAYMENTS— 111111117"HOLDINGS DEDUCTIONU NET PAY 11313SCRIPTION RATH HOURS EARNINGS REIMS & OTHER ID ALLOCATIONS PAYMENTS 300 SERVICE INSTALL RTIIOM (cont.) Fed Income Tax 59.47 ChkEl 7901 :367 6e NY Income Tax 20J,22 i CHECK 2 TOTAL. -------- ----------- ------ 3115C ----- ----:- 540186 ------------ -------- -------- ---------------------- 121'.07 --- — - 3 ------------- .......... Ne 387!66 ....... EMPLOYEE TOTAL.! 3915C 67'9;2 134164 411 Net Pay 503129 Regular 27v,'!500 11i6c 3130 bavles; Arthur Social Security 22ing Union Vaca 20;12 Readychex # 110000:!5'7,7 2 Union Vacation 11;150 750o I Medicare 5Ni Work A,,,t 22iO8 Check Amt 2114162 W(A Ausees; 11!3200 221081 Fed Income Tax 311:611 SkIng Fun -Memo 0"2000A4213C NY Income Tax 9121 Craft Trn-Mamo 012200 1 AM& NY Dissiblifty 01,6( : Health F 81,.,600 u -Memo , U.,34,96 M -Memo 041200 Industry -Memo oploo Wi4; National -Memo 3,!()400 M-14196 Pirtylit St. -Memo 41,0300 CHECK I TOTAL ------- ----------------------------- 11iso 3r, Iso -------------------------- 68V 42!21 ----------------------- Net IAy ........... N62 Union Vwation 79 Social Security 65:i1 Unon Vaca 79i Readychax 0 1 IDOOO' 2974 Work Assess i Holiday 34k200 i 26: 912113 Medicare 15i2 Fed Income Tax 17118 Work Asmnt 59:189 Chw* Amt 604:59 160 NY Income Tax 65`21 iSi -3HECK.2T0TA1J. •?L6Aj -- -------- 1,06.1p ............... ............ .......................... 307 13 ...................... Not Pa -_1304'69- ................ 11 EMPLOYEE TOTAL; 38:10( J. 1,407il 376 3 1811 Net Pay 1149,21 Hardhig, Thomas Regular 32!C1000 40( I0 .W 0 0 12i Social Security 91: Health Ins 13i18 Direct De posit # 1098 1 a Overtime 48:(000 11 411 0 1.c'2 0 Medicare 2113 i Check Amt 0:,00 Fed Income Tax 2611; NY Income 'rax 87;16 Chkjj 4209 996147 : NY Disability o :6 EMPLOYEE TOTAL: 44i00 1,47200 462:,3 13:18 Net Pay 996:47 Patton, Robert Regular 32 .000 11416:00 1 Social Security 90:3! Union Adm 40'50 Direct Deposit # 1099 g 40;00 1 i 5 Union Admin 1000 1 40:150 Medicare 2111.' Union Vaca 96139 Chei.kArnt 0.00 Linton Vacation 22'..800 1 16:39 Fed Income Tax 16816, Savg 022.6 9.1570 (Nertime 48::E000 6150 24;30 NY]'onieax -r 82g3, no Annuity: Memo 21:2000 "39.10 NY Dl,,,bilk- 6( H & W-Marno, 6iE;0DO M28r,30� HFA -Memo 1;4000 Industry -Memo 010500 i A42:01' Int I Tra-Memo 0:10001 A f4 05 0023 002346107 Arr1low Ak-Concittionirg Payroll Journal Run Da a 01/27/10 01:12 Phi Period Start - End Date 011201111-011215110 PaEo 2 of 4 Check Date 01/29110 FIYRJFZN PAYROLL JOURNAL 00230023di107 Atrtm-Air-Cordwoning EMPLOYEE NAME HOURS, EARNINGS, REIMBURSEMENTS A OTHER PAYMENTS VWTH1IOUHNGS DEDUCTIONS NET PAY ID AULOCATIONS DESCRIPTION RATE: HOURS EARNINGS REIMS a OTHER PAYMENTS s s **** 300 SERVICE INST TAON (cont.) 3 1 Lwal Pen -Memo 4;'1000 `: ; M186 05 National -Memo 01MOO W29157 ; Union Ed -Memo 0:650 j M22128 i 1 EMPLOYEE TOTAL; 40 1,467111 ` 363,04_13818 Net Pa '3 37-126 Uphoill, Michael J Regular 24;(1500 31,100 745; 1 ; Social Security 53;2 Union Vaca 54;2 Dirert Deposit # 1100 28 Union Vacation 1;160 6,4j25 i Medicare 1214 Worlt Asmnt 59;52 Check Amt 0100 Work Assess 0920 fa:52 Fed Income Tax 88i7 Chktt 2938 t351io5 Bking Fun -Memo Ou:O ` A46120 NY Income Tax 39-141 Craft Trr�Memo 0 ,200 1 Ae61-82. NY DisabI114, OE Health Fu -Memo 8 :600 M2.564*06: 1 ITf•Mema 010200 A40"62. Industry -Memo 0:2100 A46,5 Profit Sh-Memo 4;0300 1 'r M1.24M i CHECK 1 TOTAL'•_ ---------------..------- _ 311 -- 1• _ _ _ _ _ _ 8'.�"3 ---- ';•-------------- " 194" 1•---_---__--_-_--.•--------i�-•------------------_--__}- 11317 Net Pay151 05 -•--_-__-_-----..-..._�-�_ Union Vacation -.:71,00Social Security 2211 Union Vaca 27 Direst Deposit# 1101 },.. Work Assess i Holiday 3414200 " 9;0 e0 30917 Medicare 5.1 Fed Income Tax 1018 Work Asmnt 20:3 CheckAint 0:00 Chkg 293B 264108 t NY Income sax 7, UVJ 1'HECK 2 TC?TAI: 9i 3f7i1 45-17 471 Net iley _ _ 264 08 -- -- -----------------••--- r-- ------;-- ------------ �- -------^ -c-- ------- ----- -- - ----- - ----------- - ------ EMPLOYEE TOTAL; 401 1,2161 2401 161111 Net Pay =315113 COMP ANY TOTALS 8 Person(s) ? Regular " ; 2271 ` 6,7:!416 `• Social Seaxity 561; Health Ins 1311 Check Arnt 1149121 11 TmwacNon(s) Union Admin 1 ! 4.01 Medicare 128;9 Union Adm 401 Dir Dep 5,096131 i Union Vacation 397:2 Fed Income Tax 1,085:6 Union Vaca 39712 Work Assess : ' 293: NY Income •rax 433:3 Wort: Asmnt 29315 Chertime 4; 216' NY Dlsabillty' 48 : Holiday 1 ` 3515 ' 1 Annuity -Memo " .3 Bldng Fun -Memo i i 81 Craft Tm-Memo i 3419 ` H &W -Memo 237;3 HFLA -Mento 56:7 Health Fi-Memo 73713 ITI-Memo 81 Industry -Memo 30;0 0023 0 023.0107 .kirilow .Yr -Conditioning PayrollJournal Run Da' a 01/27/10 01:12 Pkl Period Slart - End Date 0120/10 - 01/26!10 Palle 3 of 4 Check Date 0.29/iCi PYRJRN PAYROLL ,JOIU RIS AL 0023 (1023-0107 Ofbvr Alr-Condiftning EMPLOYEE N/WIE— ----- -.....HOURS, EARNINGS,, REIMBURSEMI±NTS & OTHER PAYMENTS IMTHHO1JNNGS ID DiiSCRIPTION 1ZAlii HOURS; EARNINGS REINIB &OTHER PAYMENT; Inr Tra-Memo Labor Mng-Memo Local Pen -Memo National -Memo Prcft St -Memo Union Ed -Memo COMPANY 351 TOTAL Empb]'erllebNdes Social Security 551:4 Medicare 128:9; Fed Unempkry 7111E NY Unemploy 562:51 NY Re-empl Svc 6,6i NY MCTMT TD 30:24 OYER LIABILITY 11351:0; �l TAX LIABILITY 31555;2( DEDUCTIONS INET PAY ALI-OCATIONS Net Pay 5,0 0023 Q-023.6107 AirflDw,Wr-Conditlonin3 Payro i Journal Run Date 01127110 01:12 Pful Period Start - End Date 01.'20/10 - 01/26/30 Pap 4 of 4 Check Dnta 01 �29NC I,3YRJRN Jif /D Date I ` (Title) (Nama of Signatory Party) do hereby state: wise the payment of the persons employed by (1) That 1 pay or supe on the t (Contractot or bcon atter} .. ; that during the Payroll Period commencing on the LO CYt LD (Bull llll Work} 4 and ending the 1'� day of Nm —n / � d 1dayorICD (er_� all pemons employed on said protect have been paid the full weekag ly wes earned. that no rebels' have been or w01 be made either directly or IndlrectSy to ar on behalf of said from the full IC-PVl n cl {Contractor or Subcontractor} the waaldy wages earned by any person and that no dada one stble deductions asedelkted In Regutatlons Peor lryl from the fullwe es eemed by any person, other than p Co"land Act 3 (29 C.F.R Su�titie A), Issued by the Secretary of Lair Under he Cubed belay � amended (48 stat. 8 , 63 Stsrt, 108, 72 Stet 967; 76 Slat. 36T; 40 U.S•C 5 )• (2) That �,y payrolls otherwise under this contract required to be submitted for the above period are 1 correct end complete; that the Vega rates for laborers ar mechanics COMM' Intorel t Lon ct S that the corn the ct an wage rates contained m any wage determination Incorporated s set forth thamin for each laborer or mechanic conform with the wotk he performed. classftadon registered in a Mona fide in the above Pe►jOd are duly re91s the Bureau of O i (3) That any apprentices employedre ed a exists in a LL I apprenticeship Program re9�ieted Villi a State apprenticeship (ted ag Y Apprenticeship and Trainktg Unlled Steles gapadmenl of Labor, or U United such recogn Q I State, are registered oAth the Bureau of Apprenticeship and Tralnirig. United Stales Oepgtment of Labor. t (A) That: a (e) WHERI=_ FRINGE gENEF1T3 ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS � rates Aald b each laborer or mechanic listed In In addition to the basic hourly wage benefits as Gated in the contract p ' the above referenced Payroll, payments of fringe have been or will be made to appmpdata Programs for the bonatit of such I1 ees, except as noted In'eelion 4(c) below. employees, 1 o t � I m I L,_ (b) WHERE FRINGE BENEFITS ARE PAID 1N CASH — Each laborer or mechanic listed in the above referenced payro8 has been palbl as Indicated on the payroll, an amamnt not tens than the sum o basic hourly Wage rate Plus the amount of the " benefits as bled In the contract, except as(ioied section 4jo) below. low Ci a N LD LD ti Nr co co 7 0 J LL Q l CL N N O O co O LL L WEEKLY PAYROLL DspNr, en! !� "F>o►N eotillCitiOn � stBtOd — -. e....._ .., .A, r.., a--.h.e es OnHmlil Up:. Ilia OE Blit f wm 1 wft MM V'd 7,bL996L9t,9 mo-udld -- d7,95Z0 OL 80 98d LQ Q. N ti Lo Ln O ti Ln v 00 0 J LL CEO Q N Ln N O O_ 0 O t] L LL 1 oemof LOW WEEKLY PAYROLL Bweau of PtMc W&k rw con taewes Opdonsl Use. Oso of tld6 form v, On Prim ! notlBmum roq�irsmsrLts; ss sfatea Date Warne of signatory partyJ (Titlel do hereby state. - - 41) That I pay or stmervise the payment of the persons etnpiloyed by /,b6LCP1LJA 44 IS e5zr 7'4lG- � /:ti C� on the ��P/..�GEI�S /t iu�i �LA.e,4G'E IContlactor or subconraetort ]Building or Well) b� • that .during the payrolllme- 1 period aomerneing an the day of `�G 20 VAI and ending tha�_1 days( `j�' all persons employed on said prajact have boom paid the -full sleekly wages earned, that no rebates have bean of Will be made /either directly or Indirset4y to or oa.boheif of said ON/41�,is �ZE�LT72-rCC jNC from the full (Contractor or aulsoomrector) weekly wages earned by may person mind that no deduetiow have bran suede sliber dleeotfy eT indirectly from ttie full waVes scab¢ by any psrsort dther then Aerie islbM il6diletions as defined in Regulations, Part 1 r29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amanded 146 Stat_ 941L 63 Stat. 706, 72 Stat. 967, 76 Stat 4157, 44 419.0: 2700. and . described below- (21 elow - (21 That any payt'oIl'i otherwise under this contract required -to be: submitted for the above pario'd are eorreal and complete; that the wage rates for laborers or ina¢hantes auintalaeii 66ri4rt are not less then the applicable wage rates eohrtalned. in any tae's detaipdnetiah Irteorporated into the contract, that the elassifloatlons.set forth therelfi for each laborer or. mei:hanle conform with the work'ho performed. ' (4 That any appr.ntiees onVoyed is the above period are duly regiitared In -a bone fide' appreatiaeship progiem ratilaterad with a State apprsntleeship spendy tecoggited by the Bosco of Apprehrdeaship and Training; United States Department of Labor, or'4f no •seep recognized g0epcy exists Is, a state, are registered with the Bureau of Apprahtleaship sitd TrelnhilL United states Departrosnt of Labor. 441 'het 4al WHERI: FRINGE 89 419 ITS ARE PAID TO APPROVED. PLANS, TFt1NDS, OR PROGRAMS t!An addltinn to the basic hourly webs rates paNf to rich )alone' a mtittwnie listed in the above referenced payroll, payments of fringe benefits as listed in the.eontreat - hsve been or w111'bo made -to appropriate programa for -the benefit of &aid cinprayeas, except es noted in Suction mlcl below. - ' T (b) WMAE FRINGE BENEFITS ARE PAID IN CASH o ❑ - Each laborer or mechanle listed in the above referenced payroll has been paid, in � Indieatad on the.peyroll, an ernount not less than the sten of the applicable basic hourly wage rate.pitts the ahnouej of the required hinge benefits as listed is tiis ^;. contreet, except ss orated in Section AM below. o lei EXCEPTIONS EXCEP.TIGA (CAAF.'T) . EXPLAftlATiON REMARKS - �G'�� f}zll .25 '9 ^JIO I LC -1 L '77Z) NAME AW TITLE p Slt;rili47URE THE WILLFM FALSIFICATION OF"ANY OF E STATlSNJC-ar MAY JECT T -M ` CbWFIAC1'Dq OR xiscoNT•RACTo T6 Clblul Ci11h4fNAt:4a CVf S2E'SSt:'[Y[fN -1001 OF TITLE IS AND SECTION 231 OF TITLE 3t OF THE LINITEV ;. TES CODE �' U.S. Department of Labctr PAYROLL Employment Standards Administra)'Ion (For Contractor's Optional Use; See Instructions at www.dol.gov/esatwhdlformsiwh3471nstr.htm) Wage and Hour Division www.dol.90v/esatwhdlfori'nsfwh347instr.htm) ern .,..r L).S.�R7aec�dHrnlrOivf�ibb nwndev. NAA1E OF CONTRACTOR OR —SUBCONTRACTOR Rev. Dec. 2008 - ADDRESS ADDRESS €J V i -� /� �� i :r l�G `� I• i sv ! `} ": �r r p OMB No.: 1215-014C 1 t �• �.� I;?�' �r A llk)6li O i _� � i � 1d 1 _3 Expire -s: 12/31/2011 r PAYROLL M. FOR WEEK EN i;f r, PROUECTAND LOCATION ' PROJECT OR CONTRACT NO. 1+) (2) (3) (a) DAY AND OtATSr^� i5} (5L m .S 'rl W t f � nEa�norrs I9) a: o NAUE AND INDIVIDUAL t064MFYING NUMBER f-1-11 ��~ I-( F� U GRoss NET LAST OF SOCIiht..sEcuwrl WORK S )ITS d� TOTAL RATE?h MOUNT TITIN WAGES NtAteER OF VVORI�t z `: CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY LO>IVOTOTAL PAID EIRNBD FICATAX J?D.i :.+t OTf;tR p \ ; OEOUCTIONS FORWEEK 1'l,if G�lt.•L lrF..r's' {� D - s` -7 �L,G1W'!iN,& s � p ry ��`�� el, 144 01 gi-51 qp9L di $ o s Ji y.��+-1i3i L'A,4.. O f �° ats..3; a;..,� lc•s?7 t�.� �. �; �.xl' � ��-3z a�3. g" � S ,� �� 3.� C, 5 . . O S D S O WhlacorVisi on of Farre bYl'F<L17Fs eotlmaL B a ahandaian fer•eha.awaaaah..,r,,.. ,.w ..h......._..�_ O • 5 �.��__.�,. __ �..�_�.-_._ _ - - �......�.�.. y ah,al corssaem6e aed auboonlrsetors perloming hrrork on Federally fnarhrad aassisted mnskrdfm Cahrratl! .ro Tuftllslaweeldya sblmhenlvet +� d Io Oha era• ••�" w .ne.ruwmauonmuasom mM IA001 In 29 C.FJL 0 3.3.5--4a). rbe Copala d Ad 29 GF.R 5 a q Rspa gh Pald each eapbyee dning the precedM NedCr U.S. DepaArneol c(Lahec MOL) PBoAadms at $ .si )MIre require tortbadors b sd=Avreeldys copy of am reymlls b ike Federal ageneymotrae " Wcrfimakv A& a mslradlee Pr0*L aeootrtpaded bye signed *sealemani ofCompf'anee" iwdkaUng frel Ile ParraftW *mea and cvnpleee sM um each taborer vf mednrrichasheen Paid not leas Bar be proper Dav"amn l I—Mng Wage raft ror the work performed_ DCL and federal mh6acthg ageades reeelhWlg Ihls InlonnalleP raAM Ila HfoneaSwn do di teaaiae that ernyloye" how rearmed kiialty required wages and fringe benefas. Public Burden statuuent - _ We asgmale•phal Is VII take an weragear 55 aiMn tomaVete Ibis mracpon, ioduding pme forrevlaWng inftvcSorm s 9Mrk'ngerisOng datasounxs, Perim" and nahlalning the data needed. and aarplating and rauisv a iha wilecaa, ofirdalna6an. B you haat "Man"," reaarh111,91he" ess rales or arty gem asped chills ml&dfon i itladng aug&whs for iadud"a pis bunter, send Ikea to the Adahicla4ato I1..Suglen. D4.20210 L trigs ant Now Dioialdn, ESA. U.S. Oeperonenl W faro, Room 53502 290 CtasspluUorh Avernte, N.W. �7 9 4 r W U.S. ©epartrrtent of Labor Employment Standards Adm inistrallon Wage and Hour Division PAYROLL {For Contractor's Optional Use, See Instructions at www-dol.govJesahvhd!%rms/wh34Tinstr.htrn) Parson are not reatdrad to msamodgo ribs callleclien of Wonnalion unless it orrs7olars a amen& yard OMB aonwo? nwnbet. tkS. Nape>mt12�OurDietdntt --Rev. Dec. 2008 NAME OF CONTPACTORNA OR SUBCOMMACTORAODRE55 �.� (� ❑ lJ G t. J1r% =t-: i � G � G C . € ('` .ice i t`r` e- ,..- 60. &OX log- �'� �F �: i� � [� � � �. � a< 4 � i t t 1 _3 OMB No.: 1215-0149 Expires: 12!3112011 PAYROLL NaI Ii FOR WQOC e otiiG O/' C>8 --/C, I PROJECT AND LOCATION - W Pf-P011) PSAP--A C PROJECT ORCONTRACT NQ (1) . NAME AND WOIVIOIULL, IOEHIIFYING NUMBER fe.g.,LASTPOURDIGITS OF SOCfAL SECURITY NWlSER) OF VIiCRi(Eit RI I4 o I i a (3) WORK LYASSIFIC0.710N (4)GAY ANDDATE (5) TOTAL HOLM$ cH , t 14 (t RATE. OF PAY (T) pR�S.+ ANOUNr FXe1FD cat r DEDUCTIONS p m NE7 WAGES PAID FOR WEIX 9 o 1� t .-• L - E1C.A WIIH- NOLDWG TAX ((�+ T J! ^E .! i.-F�ICt OTHER TOTAL DIJCTKNJS Fi0URS1rVOR1�0 EACH ORY 143, aZeir,L ra7.�/� J:�•�� }liJ.ftD r�p(ja�`J IA'�'�•!,] i 0 - L .DRi„ u, i f 0.12 3 `� t Z�•3 v c;743"4 S Os M 3,na 0 9 a 5 D - s . O a - 0 s - 59 -v Wena mmPlawn of Forte WH U? is oplonaL it it mandatory rat coveted mrbaelom and artreonimmon prJatratg was ort raoeraey nnanaee a assrstm mna aa:mn mnuaw .+ �e�v�.••• •• •� ��.•.. w.«w.. w.c.,...,,...«.....a.....� �. s..�.,, �.-,..._ �,,,.......�,. _ W US.C. § SUS) contractors and wboont=tcre performing wvk as Fademity ditartoed a assktad mu W doaooebaots to Yirriett weekly a staNrumm with reaped bate mages psId each eam0cyae doing Me preceding week.- U.S. 1)ePadrneel W taEa (DOL)'reptlaiotfs at 29 aP_p_ 5 5S(a)(7]pq mgAm correctors tosuhadt.eeal@y a copy of all rayraftlo the Federal agengeoahadinp htor 4rvnNng the a nsitudm pealed aeeompaded bye sip %Sraremanl dC ftViare' Hfi®gng 11W the pay ols aro ooeacl and Oonplele amt Ra[ each laborer •� or media ilo has bear paid not lees then are proper Oou6-0aoon prevafng wagerateforthe Nark par0med.00Land (,dere! mnifac g ageacleereceiving 11* kdontlallort re%%wOn hdorr Som todetermuce UW ec ptoyeas have feoeived tegatllrequ"sed wages and fringe benefits- „ Public Burden Statement We asfimele tnatis will, Isle, on average of 55 wAlAas to eurnpte5a udssoo9ecgum including Ikee for r&4&4ng inslraegens, ssardting axietho data ■ousoes, gathering trd malnhMing nh■ Bala needed. mod complelbig tnd reAPMog a.a c4seewn ati- taratbn. Irydu.nave � - any-cotmner us regarding Ota-- &SUirvaes a arty dheraapect of this edladioit. Thelad ig Euygesliona roereatdteg this berdart tend there to ere Admtrislreta. Wage and How DMsroa, M& U.S. DeWffwd at labor, Roan 53502, 200 Coest9ealon Aveeae, N.W. Weshinglm. O.C. 20290 -" 40"o U.S. Department of labor Employment Standards Administration .Wage and Hour piv)sion • NAME OF CONTRACT-- 01, ONTRACTOR Suaco" r PAYROLL No. t•n HAUEANO PkiwoUAL IDENTIFYING NUMBER LAST FOUR DIGITS OF SOONL SEOJPoTY NUMeERI OF WORKER cy PAYROLL (For Contractor's Optional Use; See Instructions at www dol.govlesalwhdlfOr mslwh34Tanstr.htm) Persons are not required fo reapond to fhe m yec&n of infonnarron unless It &4ftys a C14mrlff varetd 01149 TOR Y ro+)hd number. AOORESS P101 Box iioe- GARK,,oqp1Ua IN FOR WEEN FNOING PROJECT AND LOCATdON P �) ai (q1 aaY Arlo OArE I (s) I M 1 (t) W WORK o GROSS TOTAL I RATE, AMOUNT (e) DEDUCTIONS i1.5. ��:wdE3o�Dit3s(on Rev. Dec. 2D08 Q OMBt4o.:1215-olas o Expires: 12139!2011 0 ' OR r.OtYTRACT NO. ts) v ""'Na TOTAL FrICA TAX ,� C �,.1� rC�a OTHER DEDUCnC 1tl��+�$ #�tz 0 NET WAGES PAID 147"- 1-71 1-7S- -Ill/ g s,lss 7-12.kp 1 r 4- ( f 4g U.8•.C. jt � w am vw•r-3a7 b C1350". I(I, rneedeloty hr wro Ned eonvaalas end sebarrino!ors padORnl@pvmrkos FederalfVfton ed wesslsted m �yq; lomwaw b gr. aavon ed[adion conlal7ad In 29 C.F.R. Si 39.5.5(a� TW CopW"Ad 4*aortract*r&arke.* on►adon perforo*v wrkaa Federaly6nanoed orasslsbed omrshecGon mnkaela to "(urnlsh Noddy a abMmenl tNlh rasped bele vr�es adl eoCT s 29 GFR. § 53i a)(J jragJro Lvrdraelpfa faarhenil weeklya copy ola8 payrdh hf ft Federal agency mdradlrg for drll the tonslruceoq ? n1P!� durrrg the precedinoweek.• U.S. OepeNnenl of Labor COOL) rogNipOts at or MCI onto has hoes paid not Tess tften Ale Proper Davk.gaem pravaifry wage rata Ure taora Pelcy QM d, O k and hden+leralc" The g agendesreo A Oft h2o1*db as vtna the SSfem at or CanpYana� bacau g Ural toe payrols anraurrcQ and oompeteand Ihet each laborer • - ghbwnatkn to derarmine that ernobyees twe modvedllagaly requhed waoea and hhye bevels. Pehlle 9urden Stareeaent ' We esamate Nol V W" takean avmrga 055 mhules bComplete Ws mlNcno % lndodhg Grne for rrdwArg insUtlWor� seaeirbfpesis6og data courses. _and ma Intal l/a t D.C.r19 theme e.draalesaary ober asPaCl'o( aa� ddlec6on.lbaurii9 iN`=mrinns rnrroAuciag Ibis b s*m send Ihr' m the Ad inleVatm ue+9 day mea arm compledng and,rlM@xinp me.mfedon of idomfelbn. N you irav- Washage aed Hma DNksos. ESA. U.S. Deparlmenlof LaboL Room 53502, ZOO rcvlslMaron Avanae, KW. - . U.S. Department of Labor PAYROLL and Hour Division Employment Standards Administfation (For Contractor's Optionai Use; See Instructions at www.dol.govlasafwhdlformstwh347instr.htmj - - U:S. V►TZV aAd BVw Drddoa ?D NAME OFONTRACTOR U9201ITRACTO_ADDRESSr.,..._..... CONTRACTOR OR •• •••,,r•,��....ra.--q .orw vrw.o�wchrsw nah-npGY. Rev.Dec_ )8 MB :i` G GL h0.�iR0zI—Le 1092 12!317 2011i PAYROLL NO. FOR WEEK ENDING PROJECTANDLOCATION PROJECT OR CONTRACT NQ I 0} 14)oAY�A�e{roDATE ts1 (� I» NAME AND MIVIDUAL IDENTImma mimam DEDUGTIoNs (e.g.. LAST FOUR DIGnSOF SMAL 38OMTY ORK lusty )CiF WOWrR i3o�i o TOTAL GFOOSsMT RATE AMOUNT WAGES PAD WITH. NOLDpiCa ,,((�� TOTAL CLASSIFICATION HOURS WOMtEbEACti DAY HOURS, OF PAY EARIIED FICA TAX .Ltt �i'atit �'J,.e?CL OTHER bE0UC1fON3 FORl1fEBC s �' =� �b�� t-'� aaL�g 107,39"SL,qo . 11-00,100 (��i 1 ljgo•r / ;` o s a a O s . O a - a - o a -7 r -I- N 0 0 W W —.._.._.._--.. _.. ._ T__.-_..--_..�__._.—__.--__...��_...._......._.._.__ h.............."------�., T..,.-. wo :v:amr� wonconua=meesporeooerelnlCrrtmummMcf*n oo' dedn79 C.f.R. 4§9.3.53ia). the Capdald Ad ta0 U.S.C. ¢ 9f a5) oohhkeraers andaubcwireteorspsrlaming lark m fedaafy 8haeoeCdrasslsted mesYadion -,,&eels to -(UMM areakly a slalemanl wiilh reapeCl b Uhe Wagespab each eeplayea dudnq the premd'rhi weak,• US• fXperloterhl of Lahti. tDOyaegalaionsat o1 29 C.F.R.¢ S.5400 mghikedo. +,amore to sibraltweelsy a Copy of ell rh roMv to the Federal agsagmevading for ardaaedrV Uaaasekv4cn ptctect. aoCCrnparied byam4amd'Statemehdof CemP13ance7ie6oarg 601 ace payrCJsare mrred and ttmpiele and kol cath leborer or nhedhanio has been paid Aoi less tan the proper DarfeEacon pfwailrg wags mis W Rhe work pe f= DOL snd federal eaglreeinq sDaodes reeeWfy this Inim. Ilan rndewdaekhfarrnaUm to d*Wrr*w out empioyeas he" rscairaa{,lag required wages ed kiage bamnis. Public 9mden SlafeeieahF Wer aslYhate ahatb ais lake ser aVersketl SS m'vwtes b tswrplete tds CMeta'A n, krCludieg erne lex reuiewinginskhseans,seardtYtg etdagtg dale sdnom 9aMedn9 end makdaerrkii IMo daneeded, and om oletfng agb nd ndng the cedeclion ofill-h alihut. Ryon terve anyco nents vegameft Ihaseeseaalec Ctsa/oeteraspenof the ookeENah. frzdudlrhg sadgesiotrs for ied j*i lest Mn adesad are -lot, Adx&*VaW. wage and Hour OWslm. SSA. U.S. DmWw*.et d LaboL Room S'3M 2a0 C*reMUonAvenue. Kim. Wed*Vton, O.C.-2(1219 ' (our) - . U.S_ Department efLabor EITIPJOYment Standards Administration PAYROLL (For Contractor's Optional Use; See Instructions at www.dot.govlesa/whdlformstwh34Tinstr.htm Wage and Hour Division} Persons are rw regtd2�G to respondb Ore coA'ecriorr of ' L'S.- o0 tfAsdE of CONTRACTOR OR SUBCONTRACTQQ � " if ccwlwys a cli-rrty t a6d OMS camulnumber E7aitr tom' s�'sioa - i'� G lv ` :. _ AsrDRess Rev. Dec. 2008 N I' I mo. l'�� i " -i r- ! S't">w t�� OM No.: 1215-0149 PAYROLL No. i ' '� �%iti �ic1 �: j p •/ i_ a FOR tNEEI( EW1NG t L i t ', I - 3 Expires; 112 2011 0 PA0J6CTAND LOGArION '1 9 PROJC�'T OR COrVTRACT o ni 11410AYANO DATE (5) z:a o y DEDUCTIONS (Sj t.1AltE AND MIIXVKNIAL IDENTIFYING NUMBER ` Jam•. r T te.g, VST FOUR DIGIT50F SOCUL SECURITY NappryK o - e"E F` -u GROSS WrIGTti- NET NU OP WORKER z irk CLASSIFK'.ATION HOURS LVORNEO EACH DAY THOURS Y AdOUNT HOLDING (+ WAGES t t3'L�C,'-.iiC' `'£r �.• a EAPoVED FICA TAX JT�•; •(r. �.. OTH3t TOTALUCTICPAID r r JS f FOR WEEK 0 � � 3� �'��.ND 6Q �ls.b y�(`�•a� s �i�U�i�I j � i�: hl tt• E., o 7. 3a I ria {�j�• �a,l,Q laJ.BG af.3� �t,I yD 5.20 _��.�-.0 3�. / O 3 S fo a O o z a ,o s w 1MMe w"Wleacn efFarn M -34T is optland. KIM taa dattxyfoi rorrered mrine . 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DOLand red" canhactlng agerrAs _el,4a this depart in tndtll'vtg Kral0* paMft ars oared andooaptere and that each labater 9 ittbrtaa�On r'evfery the 4'dattrtaEm to determine thai erptayees have tecewed a b9 benefits- WOgYrequiredtragesarakingePubltc Bunten Statement esdmsle that Is oil Uke ana,arage DrSs mi rules b - any oo rmmts awfdn V"@ sellme awtiiete this colhctlm, tredudinp doe 6r reda.wrg iastnu[ohs. eeardwg aadsOnp data solelseF galhedtg and rnamtalnirp IhadaU needed. and aortpletlng ane reuidtiwng 11)a aye,a, of hkanstfm res ar anV oher aspect of etlt coasaedut, h Wi!'rig tuggestioas forreduoitg ads pardon' sero Nfeshingbn, D.C. 2021 D - arena Ea UtO AMm►ikhabr, Wage and Noun DWdw.�ESA• U.S. Deparimentotlabor. Room 33502, 2DDCojnd;M6n Avenue, KW. r hsK - . MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC A Hk A 9 Elks Lane, Poughkeepsie, New York 12601 Tel: (845) 454-3411 Fax: (845) 473-1962 ❑ 64 Green Street, Suite 1, Hudson, New York 12534 Tel: (518) 828-2300 Fax: (518) 828-3963 February 4, 2010 Town of Wappinger Town Board Town Hall 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Hon. Christopher Colsey, Supervisor RE: Highway Services Garage HVAC Project Roof Repair over Garage #1 Change Order #4 Dear Mr. Colsey and Town Board Members: Enclosed please find a copy of Change Order #4. This change order was necessitated after removal of the existing roof material additional areas of the roof sheathing were found to be rotted and in very poor condition. The sub -contractor removed and replaced a total of 5 additional sheets of plywood as well as installed 2" x 10" x 10' for rotted roof joists; and primed fascia. The contractor, Airflow Air Conditioning, Refrigeration & Heating, Inc. provided the cost for material, demolition and installation as shown in the attached Change Order. The amount provided is $1,006.25. Therefore, the new contract total will be $ 257,480.25 ($256,474.00 + $1,006.25 = $257,480.25). Please place this on the agenda for the February 22, 2010 Town Board Meeting for approval of Change Order #'4. Please call me at (914) 475-5749 (cell) or (845) 454-3411 Ext. 30 (office) to discuss this matter prior to the meeting. Very truly yours, MORRIS ASSOCIATES Engineering Consultants, PLLC 4 Robe . Gr. , PE Engineer to the Town of Wappinger RJG/met Enc. Cc Albert Roberts, Town Attorney John Masterson, Town Clerk Graham Foster, Highway Superintendent Inez Maldonado Feb 02 10 02:06p AIRFLOW 8457956742 p.2 RFLO P.O. 9o%941 Highland, NV 12.208 OWNER ❑ Phonc: (545)79S-5740 Pax. (845)M"742 ARCHITECT CHANGE ORDEE 'wt+'•�rnua•airronditinningxum CONTRACTOR FIELD ❑ OTHER ❑ PROJECT: Town ofWappinger CHANGE ORDER #: 4 Highway (3arage HVAC Improvements,Firewa CHANGE ORDER DATE: 02/0112010 20 Middlebush Rd 09-005 Wappingers Falls, NY 12590 PROJECT #s: TO: Airflow Air Conditioning, Refrigeration & Heatl DATE OF CONTRACT: 0912112009 PO Box 941 FOR: Highland, NY 12528 The Contract is chanced as follows' 1- Labor and materials as follows - After removal of roof, it was determined that additional rotted plywood had to be removed and replaced with new. Replaced 5 sheets of plywood with new, furnished and Installed new 2 x 10x 10, cut to 30" for rafters & pruned fascia. Net Change Order #4 cost - Materials & Labor =$ 875.00 15% allowable override percentage (on site costs only) =$131.25 Change order #4 Lump Sum Total =$1,006.25 $240,650.00 The original Contract Sum was $15,824.00 The net change by previously authorized Change Orders is $258,474.00 The Contract Sum prior to this Change Orderwas $1,006.25 The Contract Sum will be increased by this Change Order in the amount of $257,480.25 The new Contract Sum including this Change Order will be 0 days. The Contract Time will be Increased by 0 2/112010 The date of Substantial Completion as of this Change Order therefore is Not valid until signed by all parties below. ' T f Wappinger Martis Associates ARCHITECT 9 Elks Lane Koper[ war (Typed Name) DATE 'v Airflow Air Conditioning, Rehigention & Heat1 own o CONTRACTOR OWNER PO Box 941 ADDRESS Highland, NY 12528 BY rsignalure) (Typed Name) DATE 2 1 -1 j-" 20 Middlebush Rd ADDRESS Wappingers Falls, NY 12590 BY {Signature) (Typed Name) DATE uuanwm OURW01c .,�,M.•�••-, .. _ Feb 02 10 02:06p AIRFLOW iRFLO P.O. 9ox%l Highland, VY MUI CHANGE ARDEF Phonc:(&r5rilowairt o+�x:imin.-955742 qx n.nirnox•nircond i6unin;;.cum PROJECT: TownofWappinger Highway garage HVAC improvements,Firewa 20 Middlebush Rd Wappingers Falls, NY 12590 TO: Airflow Air Conditioning, Refrigeration & Heati PO Box 941 Highland, NY 12528 8457955742 p.2 OWNER ❑ ARCHITECT X❑ CONTRACTOR ❑ FIELD ❑ OTHER ❑ CHANGE ORDER #: 4 CHANGE ORDER DATE: 02!0112010 PROJECT #s: 0"05 DATE OF CONTRACT: 09121/2009 FOR: The Contract is changed as follows: 1- Labor and materials as follows - After removal of roof, It was determined that additional rotted plywood had to be removed and replaced with new. Replaced 5 sheets of plywood with new, furnished and installed new 2 x 10x t0, cut to 30" for rafters & primed fascia. Net Change Order#4 cost - Materials & Labor =$ 875.00 15% allowable override percentage (on site costs only) =$ 131.25 Change Order 04 Lump Sum Total =$1,006.25 Morris Associates ARCHITECT 9 Elks Lane r%VP=9L viar (Tyw Name) J DATE .v , AirfiowAir Conditioning, Refrigeration & Heab Town of Wappinger CONTRACTOR OWNER PO Box 841 20 Middlebush Rd ADDRESS ADDRESS Highland, NY 12528 IaT(Sig""") l (Typed Name) .1 DATE 1) 1. ow �� Wappingers Falls, NY 12590 BY (SWUM) (Typed Name) DATE Quantum Sorrware bo¢raons, 1516, $240,650.00 The original Contract Sum was $15,824.00 The net change by previously authorized Change Orders is $255,474.00 The Contract Sum prior to this Change Order was The Contract Sum will be increased by this Change Order in the amount of $1,006.26 The new Contract Sum including this Change Order will be $257,480.25 p days. The Contract Time will be increased by 0 ?J1days. 1260 The date of Substantial Completion as of this Change Order therefore is Not valid until signed by all parties below. Morris Associates ARCHITECT 9 Elks Lane r%VP=9L viar (Tyw Name) J DATE .v , AirfiowAir Conditioning, Refrigeration & Heab Town of Wappinger CONTRACTOR OWNER PO Box 841 20 Middlebush Rd ADDRESS ADDRESS Highland, NY 12528 IaT(Sig""") l (Typed Name) .1 DATE 1) 1. ow �� Wappingers Falls, NY 12590 BY (SWUM) (Typed Name) DATE Quantum Sorrware bo¢raons, 1516,