2025-03 - MRU Preston LaborOriginal PAYROLL REPORTING FORM Page 1 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
Preston Pipelines Infrastructure LLC
CONTRACTOR'S LICENSE NO: 1059395
SPECIALITY LICENSE NO:
ADDRESS
133 Bothelo Avenue , MILPITAS, CA 95035
PAYROLL NO.
31
FOR WEEK ENDING
03/02/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: UB1L0302221825D
PROJECT OR CONTRACT NO: DC08272024
PROJECT AND LOCATION: Vallco-Continuation of Make Ready Utilities / CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateMonTueWedThuFriSatSun
24 25 26 27 28 01 02
HOURS WORKED EACH DAY
Aurelio Garcia
1933 EVERGLADE AVE
SAN JOSE, CA 95122
xxx-xx-8808
S/1
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 38.50 1,232.00
1,894.82
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,574.43 DD157443
03/07/2025O
144.96 22.74 3.51 112.32
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 152.69 320.39
Jose L Martinez
420 LATHROP ROAD
LATHROP, CA 95330
xxx-xx-5541
M/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 1; Group 1(B)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 64.62 2,213.24
3,679.39
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,419.30 DD241930
03/07/2025O1.50 1.50 96.93
281.47 541.50 219.22 44.15 3.51 117.59 10.60 355.10 10.46 350.41
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 17.42 4.82 161.47 173.75 1,260.09
Miguel A Ojeda Garcia
517 WARD RD
LOS BANOS, CA 93635
xxx-xx-6333
M/1
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 8-A (Area 1)
S 8.00 8.00 52.68 421.44
2,477.22
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,006.49 DD200649
03/07/2025O
189.51 29.73 6.06 48.48 10.84 86.72 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 4.11 32.88 251.49 470.73
Fabian Perez-espinoza
2023 EVERGLADE ST
HAYWARD, CA 94545
xxx-xx-5916
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 37.50 1,650.00
2,955.12
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,715.57 DD171557
03/07/2025O2.00 2.00 2.00 2.00 8.00 56.25
226.07 542.13 218.27 35.46 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 217.62 1,239.55
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 1 of 8
Original PAYROLL REPORTING FORM Page 2 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
Preston Pipelines Infrastructure LLC
CONTRACTOR'S LICENSE NO: 1059395
SPECIALITY LICENSE NO:
ADDRESS
133 Bothelo Avenue , MILPITAS, CA 95035
PAYROLL NO.
31
FOR WEEK ENDING
03/02/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: UB1L0302221825D
PROJECT OR CONTRACT NO: DC08272024
PROJECT AND LOCATION: Vallco-Continuation of Make Ready Utilities / CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateMonTueWedThuFriSatSun
24 25 26 27 28 01 02
HOURS WORKED EACH DAY
Juan M Recendez
509 ROMA ST
LOS BANOS, CA 93635
xxx-xx-7105
M/2
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 43.50 1,392.00
2,568.00
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,780.42 DD178042
03/07/2025O
196.44 278.81 106.01 30.82 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 175.50 787.58
Beau A Reynolds
36212 S. CHRISMAN RD.
TRACY, CA 95377
xxx-xx-8964
M/3
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 2.00 2.00 2.00 2.00 8.00 74.62 596.96
3,227.20
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,159.13 DD215913
03/07/2025O
246.89 387.45 152.60 38.73 6.06 48.48 10.84 86.72 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 4.11 32.88 242.40 1,068.07
Jesus C Ruiz
2038 LINDEN ST
LIVERMORE, CA 94551
xxx-xx-9817
S/1
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 45.50 1,456.00
2,534.48
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,548.29 DD154829
03/07/2025O
193.89 421.33 172.08 30.41 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 168.48 986.19
Luis A Zepeda
25509 FRANKLIN
AVENUE
HAYWARD, CA 94544
xxx-xx-2421
S/0
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 3 (Area 1)
S 8.00 8.00 8.00 8.00 32.00 65.62 2,099.84
3,807.61
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,121.49 DD212149
03/07/2025O
291.28 746.73 305.48 45.69 6.06 193.92 10.84 346.88 11.28 360.96
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 38.72 4.11 131.52 296.94 1,686.12
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 2 of 8
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/6/2025
Jocelyn Cortes Payroll Administrator do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
Preston Pipelines Infrastructure LLC on the Vallco-Continuation of Make Ready Utilities
(Contract/Subcontract: DC08272024) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 24th day of February 2025 , and ending the 2nd day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
Preston Pipelines Infrastructure LLC from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice 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 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 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:
NAME AND TITLE SIGNATURE
Jocelyn Cortes
Payroll Administrator
03/06/2025 14:45:10
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR
CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 3 of 8
Iteration 1 PAYROLL REPORTING FORM Page 1 of 1
NAME OF CONTRACTOR OR SUBCONTRACTOR
Preston Pipelines Infrastructure LLC
CONTRACTOR'S LICENSE NO: 1059395
SPECIALITY LICENSE NO:
ADDRESS
133 Bothelo Avenue , MILPITAS, CA 95035
PAYROLL NO.
31
FOR WEEK ENDING
03/02/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: UB1L0302221825D
PROJECT OR CONTRACT NO: DC08272024
PROJECT AND LOCATION: Vallco-Continuation of Make Ready Utilities / CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateMonTueWedThuFriSatSun
24 25 26 27 28 01 02
HOURS WORKED EACH DAY
Aurelio Garcia
1933 EVERGLADE AVE
SAN JOSE, CA 95122
xxx-xx-8808
S/1
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
DD157443
03/07/2025O
10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
O
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 4 of 8
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/6/2025
Jocelyn Cortes Payroll Administrator do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
Preston Pipelines Infrastructure LLC on the Vallco-Continuation of Make Ready Utilities
(Contract/Subcontract: DC08272024) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 24th day of February 2025 , and ending the 2nd day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
Preston Pipelines Infrastructure LLC from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice 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 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 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:
NAME AND TITLE SIGNATURE
Jocelyn Cortes
Payroll Administrator
03/06/2025 14:52:07
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR
CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 5 of 8
Final (after all iterations)PAYROLL REPORTING FORM Page 1 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
Preston Pipelines Infrastructure LLC
CONTRACTOR'S LICENSE NO: 1059395
SPECIALITY LICENSE NO:
ADDRESS
133 Bothelo Avenue , MILPITAS, CA 95035
PAYROLL NO.
31
FOR WEEK ENDING
03/02/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: UB1L0302221825D
PROJECT OR CONTRACT NO: DC08272024
PROJECT AND LOCATION: Vallco-Continuation of Make Ready Utilities / CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateMonTueWedThuFriSatSun
24 25 26 27 28 01 02
HOURS WORKED EACH DAY
Aurelio Garcia
1933 EVERGLADE AVE
SAN JOSE, CA 95122
xxx-xx-8808
S/1
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 38.50 1,232.00
1,894.82
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,574.43 DD157443
03/07/2025O
144.96 22.74 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 152.69 320.39
Jose L Martinez
420 LATHROP ROAD
LATHROP, CA 95330
xxx-xx-5541
M/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 1; Group 1(B)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 64.62 2,213.24
3,679.39
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,419.30 DD241930
03/07/2025O1.50 1.50 96.93
281.47 541.50 219.22 44.15 3.51 117.59 10.60 355.10 10.46 350.41
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 17.42 4.82 161.47 173.75 1,260.09
Miguel A Ojeda Garcia
517 WARD RD
LOS BANOS, CA 93635
xxx-xx-6333
M/1
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 8-A (Area 1)
S 8.00 8.00 52.68 421.44
2,477.22
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,006.49 DD200649
03/07/2025O
189.51 29.73 6.06 48.48 10.84 86.72 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 4.11 32.88 251.49 470.73
Fabian Perez-espinoza
2023 EVERGLADE ST
HAYWARD, CA 94545
xxx-xx-5916
S/0
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 37.50 1,650.00
2,955.12
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,715.57 DD171557
03/07/2025O2.00 2.00 2.00 2.00 8.00 56.25
226.07 542.13 218.27 35.46 3.51 140.40 10.60 424.00 10.46 418.40
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 20.80 4.82 192.80 217.62 1,239.55
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 6 of 8
Final (after all iterations)PAYROLL REPORTING FORM Page 2 of 2
NAME OF CONTRACTOR OR SUBCONTRACTOR
Preston Pipelines Infrastructure LLC
CONTRACTOR'S LICENSE NO: 1059395
SPECIALITY LICENSE NO:
ADDRESS
133 Bothelo Avenue , MILPITAS, CA 95035
PAYROLL NO.
31
FOR WEEK ENDING
03/02/2025
SELF-INSURED CERTIFICATE NO:
WORKER'S COMPENSATION POLICY NO: UB1L0302221825D
PROJECT OR CONTRACT NO: DC08272024
PROJECT AND LOCATION: Vallco-Continuation of Make Ready Utilities / CA
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY
NUMBER
OF WORKER
(2)
NO
O
F
W
I
T
H
-
HO
L
D
I
N
G
EX
E
M
P
T
I
O
N
S
(3)
WORK
CLASSIFICATION
ST
/
O
T
/
D
T
/
H
T
(4) DAY AND DATE (5)
TOTAL
HOURS
(6)
RATE
OF PAY
CASH
FRINGE
(7)
GROSS
AMOUNT
EARNED
(THIS / ALL)
(8)
DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS
(9)
NET WAGES
PAID FOR
WEEK
(10)
Check No.
/DateMonTueWedThuFriSatSun
24 25 26 27 28 01 02
HOURS WORKED EACH DAY
Juan M Recendez
509 ROMA ST
LOS BANOS, CA 93635
xxx-xx-7105
M/2
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 43.50 1,392.00
2,568.00
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,780.42 DD178042
03/07/2025O
196.44 278.81 106.01 30.82 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 175.50 787.58
Beau A Reynolds
36212 S. CHRISMAN RD.
TRACY, CA 95377
xxx-xx-8964
M/3
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 4 (Area 1)
S 2.00 2.00 2.00 2.00 8.00 74.62 596.96
3,227.20
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,159.13 DD215913
03/07/2025O
246.89 387.45 152.60 38.73 6.06 48.48 10.84 86.72 11.28 90.24
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 9.68 4.11 32.88 242.40 1,068.07
Jesus C Ruiz
2038 LINDEN ST
LIVERMORE, CA 94551
xxx-xx-9817
S/1
CA 2024-1
Journeyman
Santa Clara
Laborer And Related
Classifications
Group 3; Group 3 (A)
(Area 1)
S 8.00 8.00 8.00 8.00 32.00 45.50 1,456.00
2,534.48
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
1,548.29 DD154829
03/07/2025O
193.89 421.33 172.08 30.41 3.51 112.32 10.60 339.20 10.46 334.72
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 0.52 16.64 4.82 154.24 168.48 986.19
Luis A Zepeda
25509 FRANKLIN
AVENUE
HAYWARD, CA 94544
xxx-xx-2421
S/0
CA 2024-1
Journeyman
Santa Clara
Operating Engineer
(Heavy And Highway
Work)
Group 3 (Area 1)
S 8.00 8.00 8.00 8.00 32.00 65.62 2,099.84
3,807.61
FICA FED
TAX
STATE
TAX / LT SDI VAC
HOLIDAY
HEALTH
& WELF PENSION
2,121.49 DD212149
03/07/2025O
291.28 746.73 305.48 45.69 6.06 193.92 10.84 346.88 11.28 360.96
TRAING OTHER
REIMB.DUES TRAV
SUBS
OTHER
FRINGE
OTHER
DEDS
TOTAL
DEDUCTS
D 1.21 38.72 4.11 131.52 296.94 1,686.12
S = STRAIGHT TIME
O = OVERTIME
D = DOUBLETIME
SDI = STATE DISABILITY INSURANCE
OTHER-Any other deductions and/or payments whether or not included orrequired by prevailing wage determinations must be separately listed.Use extra sheet(s) if
necessary
CERTIFICATION MUST be completed
(See Statement of Compliance)
Printed Date: 4/13/2025 Page 7 of 8
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date: 3/6/2025
Jocelyn Cortes Payroll Administrator do hereby certify under penalty of perjury:
(Name of Signatory Party)(Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
Preston Pipelines Infrastructure LLC on the Vallco-Continuation of Make Ready Utilities
(Contract/Subcontract: DC08272024) : that during the payroll period
(Contractor or Subcontractor) (Building or Work)
commencing on the 24th day of February 2025 , and ending the 2nd day of March 2025 ,
all persons employed on said project have been paid and full weekly wages earned,that no rebates have
been or will be made either directly or indirectly to or on behalf of said
Preston Pipelines Infrastructure LLC from the full weekly sums earned by any person
(Contractor or Subcontractor)
and that no deductions have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as 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 than the applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship
agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are
registered with the the Bureau of Apprentice 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 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 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:
NAME AND TITLE SIGNATURE
Jocelyn Cortes
Payroll Administrator
03/06/2025 14:52:07
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR
CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE
Signed under penalty of perjury
Printed Date: 4/13/2025 Page 8 of 8