HomeMy WebLinkAbout250715-25022-WH347-Lake Elsinore from 06.09.25-06.29.25 (weeks 1-3) City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
U.S. Department of Labor PAYROLL
Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347!nstr.htm)
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev. Dec.20084NNO
U.S.Wage and Hour Division
NAME OF CONTRACTOR ❑X OR SUBCONTRACTOR ADDRESS: OMB No.: 1235-0008
Leonida Builders Inc 32023 Crown Valley Road,Acton,CA,93510 Expires: 09/30/2026
PAYROLL NO. FOR WEEK ENDING: PROJECT AND LOCATION: PROJECT OR CONTRACT NO.
1 6/15/2025 City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement,420 E.Lakeshore Dr., 20250580287
Lake Elsinore,CA,92530
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL ° NET WAGES
o O6/09 06/10 06/11 06/12 O6/13 06/14 O6/15 WITH- TOTAL
IDENTIFYING NUMBER 3 w PAID FOR
x STATE LOCAL
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING TAX TAX OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER °z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TIONS
ALVAREZ MARTIN,RUBEN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.46 $1,422.88
0 269.34 488.41 266.68 42.25 79.24 1,145.92 2,454.08
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $88.93
$3,600.00
ALVAREZ MARTIN,RUBEN Operating Engineer
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.46 $1,452.00
0 269.34 488.41 266.68 42.25 79.24 1,145.92 2,454.08
S 0.00 0.00 0.00 8.00 8.00 0.00 0.00 16.00 $90.75
$3,600.00
ALVAREZ,MIGUEL MARTIN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.85 $2,916.48
0 237.08 359.27 159.86 37.19 82.99 876.39 2,280.09
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $91.14
$3,156.48
CRUZ,JUAN Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $2,268.48
0 214.83 399.11 150.68 33.70 0.00 798.32 2,009.84
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $70.89
$2,808.16
FAVELA,VICTOR Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $2,268.48
0 214.83 235.65 127.14 33.70 0.00 611.32 2,196.84
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $70.89
$2,808.16
FERNANDEZ,RAMON Laborer and Related
Classifications/Group 1 ffis
0.00 0.00 0.00 0.00 0.00 0.00 $24.06 $1,441.20
0 207.02 272.80 183.34 32.47 287.49 983.12 1,978.96
8.00 4.00 0.00 0.00 0.00 20.00 $72.06
$2,962.08
Page 1 of 4
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue Wed Thu Fri I Sat Sun DEDUCTIONS
�o rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06109 06110 06111 06/12 06/13 06/14 06/15 WITH- TOTAL
IDENTIFYING NUMBER 3 w PAID FOR
FICA HOLDING STATE LOCAL OTHER DEDUC-
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT TAX TAX WEEK
SECURITY NUMBER)OF WORKER d CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TIONS
FERNANDEZ,RAMON Operating Engineer/
Group 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.28 $364.96
0 1 1 1207.02 272.80 183.34 32.47 287.49 983.12 1,978.96
S 0.00 0.00 0.00 4.00 0.00 0.00 0.00 4.00 $91.24
$2,962.08
FERNANDEZ,RAMON Cement Mason/Cement $579.44
Mason,curb and Ginter Machine Operator;Clary O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.43
and Similar type of
0 screed Operator 207.02 272.80 183.34 32.47 287.49 983.12 1,978.96
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.43
$2,962.08
FERNANDEZ,RAYMOND Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.56 $2,222.08
0 179.84 357.41 153.29 28.21 71.27 790.02 1,632.06
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $69.44
$2,422.08
LOPEZ REYNOSO,JOSE DEJESUS Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.75 $2,196.16
0 198.18 212.62 174.67 31.09 154.61 771.17 1,974.03
S 0.00 8.00 8.00 8.00 8.00 0.00 0.00 32.00 $68.63
$2,745.20
MONTES SR.,ORLANDO Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.92 $1,100.80
0 188.15 177.05 145.50 29.51 241.21 781.42 1,788.98
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $68.80
$2,570.40
MONTES SR.,ORLANDO Cement Mason/Cement $566.32
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.29
Machine Operator;Clary
and Similar type of
0 screed Operator 188.15 177.05 145.50 29.51 241.21 781.42 1,788.98
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $70.79
$2,570.40
RAMIREZARANDA,ROBERTO Cement Mason/Cement $1,166.08 Mason,Curb and Ginter 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38
Machine Operator,Clary
and Similar type of
0 screed Operator 202.60 173.57 116.23 31.78 105.36 629.54 2,056.62
S 0.00 8.00 0.00 0.00 8.00 0.00 0.00 16.00 $72.88
$2,686.16
RAMIREZ,JUAN Cement Mason/Cement
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.93 $571.44
Machine Operator;Clary
and Similar type of
0 screed Operator 144.88 255.38 109.70 22.73 156.45 689.14 1,290.22
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $71.43
$1,979.36
Page 2 of 4
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
og rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06109 06110 06111 06/12 06/13 06/14 06/15 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
ROMO,ARMANDO CARDONA Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $1,205.13
0 1 1 1 244.04 379.27 169.16 38.28 0.00 830.75 2,359.30
S 0.00 8.00 3.00 3.00 3.00 0.00 0.00 17.00 $70.89
$3,190.05
ROMO,ARMANDO CARDONA Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $1,417.80
0 244.04 379.27 169.16 38.28 0.00 830.75 2,359.30
S 0.00 0.00 5.00 5.00 5.00 0.00 0.00 15.00 $94.52
$3,190.05
VEGA,RUTILIO Laborer and Related
Classifications/Group 4 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $23.24 $1,674.48
0 207.78 464.94 190.67 32.59 177.15 1,073.13 1,713.35
S 0.00 8.00 8.00 0.00 8.00 0.00 0.00 24.00 $69.77
$2,786.48
While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a).The Copeland Act(40
U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week."U.S.Department of Labor(DOL)regulations at 29 C.F.R
§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or
mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Public Burden Statement
We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.If you have any
comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W.Washington,D.C.20210
(over)
Page 3 of 4
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Date: 7/15/2025 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
I Panagiotis Leonida PRESIDENT rx-1— Each laborer or mechanic listed in the above referenced payroll has been paid,
(Name of Signatory Party) (Title) 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
do hereby state: the contract,except as noted in section 4(c)below.
(1)That I pay or supervise the payment of the persons employed by
Leonida Builders Inc on the (c) EXCEPTIONS
(Contractor or Subcontractor)
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA EXCEPTION(CRAFT) EXPLANATION
Sidewalk Improvement ; that during the payroll period commencing on the
(Building or Work) Training. Training paid to California Apprenticeship Council.
09 day of June 2025 and ending the 15 day of June 2025
all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or
will be made either directly or indirectly to or on behalf of said
Leonida Builders Inc from the full
(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.967;76 Stat.357;40 U.S.C.§3145),and described below:
Permissible Deductions:
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash
fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
(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
Bureau of Apprenticeship and Training,United States Department of Labor. NAME AND TITLE SIGNATURE
(4)That: Panagiotis Leonida, PRESIDENT Pa4ia o'Lem
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY
�— in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL
referenced payroll,payments of fringe benefits as listed in the contract have been or will be PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31
made to appropriate programs for the benefit of such employees,except as noted in section 4 OF THE UNITED STATES CODE.
(c)below.
Page 4 of 4
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
U.S. Department of Labor PAYROLL
Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347!nstr.htm)
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev. Dec.20084NNO
U.S.Wage and Hour Division
NAME OF CONTRACTOR ❑X OR SUBCONTRACTOR ADDRESS: OMB No.: 1235-0008
Leonida Builders Inc 32023 Crown Valley Road,Acton,CA,93510 Expires: 09/30/2026
PAYROLL NO. FOR WEEK ENDING: PROJECT AND LOCATION: PROJECT OR CONTRACT NO.
2 6/22/2025 City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement,420 E.Lakeshore Dr., 20250580287
Lake Elsinore,CA,92530
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL ° NET WAGES
o 06/16 06/17 06/18 O6/19 O6/20 06/21 O6/22 WITH- TOTAL
IDENTIFYING NUMBER 3 w PAID FOR
x STATE LOCAL
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING TAX TAX OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER °z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TIONS
ALEGRIAANAYA,AURELIO Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $354.45
0 136.24 165.09 98.16 21.37 0.00 420.86 1,360.16
S 0.00 0.00 5.00 0.00 0.00 0.00 0.00 5.00 $70.89
$1,781.02
ALEGRIAANAYA,AURELIO Cement Mason I Cement $801.68 Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38
Machine Operator;Clary
and Similar type of
0 screed Operator 136.24 165.09 98.16 21.37 0.00 420.86 1,360.16
S 0.00 0.00 3.00 0.00 8.00 0.00 0.00 11.00 $72.88
$1,781.02
ALVAREZ MARTIN,RUBEN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.46 1$2,178.00
0 271.64 495.01 269.75 42.61 79.24 1,158.25 2,471.75
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $90.75
$3,630.00
ALVAREZ,MIGUEL MARTIN Operating Engineer/
Group 8 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.85 $2,916.48
0 274.50 466.87 209.89 43.06 82.99 1,077.31 2,568.29
S 8.00 8.00 8.00 0.00 8.00 0.00 0.00 32.00 $91.14
$3,645.60
CRUZ,JUAN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $2,265.84
0 173.33 272.04 95.20 27.19 0.00 567.76 1,698.08
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $94.41
$2,265.84
FAVELA,VICTOR Laborer and Related
Classifications/Group 4 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $1,764.96
0 224.22 265.14 139.51 35.17 0.00 664.04 2,267.00
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $73.54
$2,931.04
Page 1 of 5
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06116 06117 06118 06/19 06120 06121 06122 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER °z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
FAVELA,VICTOR Cement Mason/Cement $583.04
Mason,curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38
Machine Operator;Clary
and Similar type of
0 screed Operator 224.22 265.14 139.51 35.17 0.00 664.04 2,267.00
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.88
$2,931.04
FERNANDEZ,RAMON Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.06 $144.12
0 230.89 341.47 215.27 36.22 287.49 1,111.34 2,162.85
S 2.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 $72.06
$3,274.19
FERNANDEZ,RAMON Operating Engineer/
Group 4 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.28 $729.92
0 230.89 341.47 215.27 36.22 287.49 1,111.34 2,162.85
S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $91.24
$3,274.19
FERNANDEZ,RAMON Operating Engineer/
Group 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.28 $1,097.52
0 230.89 341.47 215.27 36.22 287.49 1,111.34 2,162.85
S 4.00 0.00 8.00 0.00 0.00 0.00 0.00 12.00 $91.46
$3,274.19
FERNANDEZ,RAMON Cement Mason/Cement $144.86
Machine Operator;Clary
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.43
and Similar type of
0 screed operator 230.89 341.47 215.27 36.22 287.49 1,111.34 2,162.85
S 2.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 $72.43
$3,274.19
FERNANDEZ,RAYMOND Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.56 $2,222.08
0 207.03 442.73 189.66 32.48 71.27 943.17 1,834.43
S
1 8.00 8.00 8.00 0.00 8.00 0.00 0.00 32.00 $69.44
$2,777.60
FRANCO GARDUNO,RAUL Laborer and Related
Classifications/Group 1 ESO
0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $567.12
0 132.13 148.71 89.50 20.73 0.00 391.07 1,336.16
0.00 8.00 0.00 0.00 0.00 0.00 8.00 $70.89
$1,727.23
FRANCO GARDUNO,RAUL Cement Mason/Cement
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38 $364.40
Machine Operator;Clary
and Similar type of
0 screed Operator 132.13 148.71 89.50 20.73 0.00 391.07 1,336.16
S 0.00 0.00 0.00 0.00 5.00 0.00 0.00 5.00 $72.88
$1,727.23
Page 2 of 5
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06116 06117 06118 06/19 06120 06121 06122 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
LOPEZ REYNOSO,JOSE DEJESUS Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.75 $1,647.12
0 1 1 1198.18 212.62 174.67 31.09 154.61 771.17 1,974.03
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $68.63
$2,745.20
MONTES SR.,ORLANDO Operating Engineer/
Group 3 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $31.14 $362.44
0 210.09 211.46 174.84 32.96 241.21 870.56 1,986.59
S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 $90.61
$2,857.15
MONTES SR.,ORLANDO Cement Mason/Cement
Mason,curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.29 $283.16
Machine Operator;Clary
and Similar type of
0 screed Operator 210.09 211.46 174.84 32.96 241.21 870.56 1,986.59
S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 $70.79
$2,857.15
PADILLA,HECTOR Cement Mason/Cement
Mason,curt and Clary O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38 $1,530.48
Machine Operator;;Clary
and Similar type of
0 screed Operator 225.15 286.48 143.90 35.32 0.00 690.85 2,252.26
S 8.00 8.00 0.00 0.00 5.00 0.00 0.00 21.00 $72.88
$2,943.11
RAMIREZ ARANDA,ROBERTO Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $432.06
0 238.20 275.96 161.36 37.37 105.36 818.25 2,333.32
S 4.00 0.00 2.00 0.00 0.00 0.00 0.00 6.00 $72.01
$3,151.57
RAMIREZ ARANDA,ROBERTO Operating Engineer/
Groups O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $849.69
0 238.20 275.96 161.36 37.37 105.36 818.25 2,333.32
S 4.00 2.00 3.00 0.00 0.00 0.00 0.00 9.00 $94.41
j
RAMIREZARANDA,ROBERTO Cement Mason/Cement $1,020.32
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.38
Machine Operator;Clary
and Similar type of
0 screed Operator 238.20 275.96 161.36 37.37 105.36 818.25 2,333.32
S 0.00 6.00 3.00 0.00 5.00 0.00 0.00 14.00 $72.88
$3,151.57
RAMIREZ,JUAN Cement Mason/Cement
Mason,Curb and Gutter O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $25.93 $928.59
Machine Operator;Clary
and Similar type of
0 screed Operator 215.63 469.72 204.32 33.83 156.45 1,079.95 1,824.35
S 8.00 0.00 0.00 0.00 5.00 0.00 0.00 13.00 $71.43 $2,904.30
Page 3 of 5
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
og rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06116 06117 06118 06/19 06120 06121 06122 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
ROMO,ARMANDO CARDONA Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $992.46
0 1 1 1 249.44 394.82 176.39 39.13 0.00 859.78 2,400.94
S 4.00 3.00 3.00 0.00 4.00 0.00 0.00 14.00 $70.89
$3,260.72
ROMO,ARMANDO CARDONA Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $188.82
0 249.44 394.82 176.39 39.13 0.00 859.78 2,400.94
S 0.00 2.00 0.00 0.00 0.00 0.00 0.00 2.00 $94.41
$3,260.72
ROMO,ARMANDO CARDONA Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $1,512.32
0 249.44 394.82 176.39 39.13 0.00 859.78 2,400.94
S 4.00 3.00 5.00 0.00 4.00 0.00 0.00 16.00 $94.52
$3,260.72
VEGA,RUTILIO Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $23.24 $536.96
0 204.88 455.82 186.78 32.14 177.15 1,056.77 1,691.71
S 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $67.12
$2,748.48
VEGA,RUTILIO Cement Mason/Cement $345.55
Mason,curb and Gutter !S10
0.00 0.00 0.00 0.00 0.00 0.00 $23.61
Machine Operator;Clary
and Similar type of
0 screed operator 204.88 455.82 186.78 32.14 177.15 1,056.77 1,691.71
0.00 0.00 5.00 0.00 0.00 5.00 $69.11
$2,748.48
While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a).The Copeland Act(40
U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week."U.S.Department of Labor(DOL)regulations at 29 C.F.R
§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or
mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Public Burden Statement
We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.If you have any
comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W.Washington,D.C.20210
(over)
Page 4 of 5
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Date: 7/15/2025 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
I Panagiotis Leonida PRESIDENT rx-1— Each laborer or mechanic listed in the above referenced payroll has been paid,
(Name of Signatory Party) (Title) 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
do hereby state: the contract,except as noted in section 4(c)below.
(1)That I pay or supervise the payment of the persons employed by
Leonida Builders Inc on the (c) EXCEPTIONS
(Contractor or Subcontractor)
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA EXCEPTION(CRAFT) EXPLANATION
Sidewalk Improvement ; that during the payroll period commencing on the
(Building or Work) Training. Training paid to California Apprenticeship Council.
16 day of June 2025 and ending the 22 day of June 2025
all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or
will be made either directly or indirectly to or on behalf of said
Leonida Builders Inc from the full
(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.967;76 Stat.357;40 U.S.C.§3145),and described below:
Permissible Deductions:
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash
fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
(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
Bureau of Apprenticeship and Training,United States Department of Labor. NAME AND TITLE SIGNATURE
(4)That: Panagiotis Leonida, PRESIDENT Pa4ia o'Lem
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY
�— in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL
referenced payroll,payments of fringe benefits as listed in the contract have been or will be PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31
made to appropriate programs for the benefit of such employees,except as noted in section 4 OF THE UNITED STATES CODE.
(c)below.
Page 5 of 5
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
U.S. Department of Labor PAYROLL
Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347!nstr.htm)
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev. Dec.20084NNO
U.S.Wage and Hour Division
NAME OF CONTRACTOR ❑X OR SUBCONTRACTOR ADDRESS: OMB No.: 1235-0008
Leonida Builders Inc 32023 Crown Valley Road,Acton,CA,93510 Expires: 09/30/2026
PAYROLL NO. FOR WEEK ENDING: PROJECT AND LOCATION: PROJECT OR CONTRACT NO.
3 6/29/2025 City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement,420 E.Lakeshore Dr., 20250580287
Lake Elsinore,CA,92530
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (a) (9)
z Mon Tue wed Thu Fri I Sat Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL ° NET WAGES
f o 06123 06/24 06/25 06126 06127 06/28 06129 WITH- TOTAL
IDENTIFYING NUMBER 3 w PAID FOR
x STATE LOCAL
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING TAX TAX OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER °z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TIONS
ALEGRIAANAYA,AURELIO Laborer and Related
Classifications/Group l O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $141.78
0 222.71 37251 213.78 34.93 0.00 843.93 2,067.29
S 0.00 0.00 0.00 0.00 2.00 0.00 0.00 2.00 $70.89
$2,911.22
ALEGRIAANAYA,AURELIO Cement Mason I Cement $1,603.36
Mason,Curb and Gutter MS
0.00 0.00 0.00 0.00 0.00 0.00 $27.38
Machine Operator;Clary
and Similar type of
0 screed Operator 222.71 372.51 213.78 34.93 0.00 843.93 2,067.29
8.00 0.00 6.00 0.00 0.00 22.00 $72.88
$2,911.22
ALVAREZ MARTIN,RUBEN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.46 $1,951.13
0 241.63 408.71 229.62 37.90 79.24 997.10 2,240.62
S 8.00 0.00 0.00 8.00 5.50 0.00 0.00 21.50 $90.75
$3,237.72
ALVAREZ,JAVIER Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $22.67 $465.85
0 232.28 541.76 223.42 36.44 109.55 1,143.45 1,983.48
S 0.00 7.00 0.00 0.00 0.00 0.00 0.00 7.00 $66.55
$3,126.93
ALVAREZ,JAVIER Operating Engineer/
Group 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $28.89 $1,502.12
0 232.28 541.76 223.42 36.44 109.55 1,143.45 1,983.48
S 0.00 1.00 0.00 8.00 8.00 0.00 0.00 17.00 $88.36
$3,126.93
ALVAREZ,MIGUEL MARTIN Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.85 $1,456.48
0 274.36 466.48 209.71 43.04 82.99 1,076.58 2,567.26
S 0.00 0.00 0.00 8.00 8.00 0.00 0.00 16.00 $91.03
$3,643.84
Page 1 of 6
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9)
z" Mon Tue Wed Thu Fri I Sat Sun DEDUCTIONS
00
NAME AND INDIVIDUAL NET WAGES
0 06/23 06/24 06/25 06/26 06/27 06/28 06/29 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
FICA HOLDING STATE LOCAL OTHER DEDUC-
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT TAX TAX TAX TIONS WEEK
SECURITY NUMBER)OF WORKER 0 CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED
ALVAREZ,MIGUEL MARTIN Operating Engineer/
Group B O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $29.85 $2,187.36
0 274.36 466.48 209.71 43.04 82.99 1,076.58 2,567.26
S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 $91.14
$3,643.84
CRUZ,JUAN Operating Engineer/
Group 6 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $755.28
0 57.78 32.26 7.37 9.06 0.00 106.47 648.81
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $94.41
$755.28
FAVELA,VICTOR Laborer and Related
Classifications/Group s O 0.00 0.50 1.50 0.00 0.00 0.00 0.00 2.00 $92.83 $752.78
0 242.50 322.48 163.95 38.04 0.00 766.97 2,402.96
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $70.89
$3,169.93
FAVELA,VICTOR Laborer and Related
Classifications/Group 4 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $588.32
0 242.50 322.48 163.95 38.04 0.00 766.97 2,402.96
S 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $73.54
$3,169.93
FAVELA,VICTOR Cement Mason I Cement
Mason,Curb and Clary O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $95.63 $1,261.71
Machine Operator;;Clary
and Similar type of
0 screed operator 242.50 322.48 163.95 38.04 0.00 766.97 2,402.96
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $72.88
$3,169.93
FERNANDEZ,RAMON Laborer and Related
Classifications/Group 1 O 0.00 1.00 2.50 0.00 0.00 0.00 0.00 3.50 $96.06 $1,128.87
0 243.18 376.80 231.70 38.15 287.49 1,177.32 2,257.50
S 3.00 0.00 0.00 8.00 0.00 0.00 0.00 11.00 $72.06
$3,434.82
FERNANDEZ,RAMON Operating Engineer/
Group 3 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.28 r$j
0 243.18 376.80 231.70 38.15 287.49 1,177.32 2,257.50
S 3.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 $89.75
FERNANDEZ,RAMON Operating Engineer/
Group 6 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.28 $274.38
0 243.18 376.80 231.70 38.15 287.49 1,177.32 2,257.50
S 0.00 0.00 0.00 0.00 3.00 0.00 0.00 3.00 $91.46
$3,434.82
Page 2 of 6
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
io rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06123 06124 06125 06126 06127 06128 06129 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
FERNANDEZ,RAMON Cement Mason/Cement :dZ
Mason,curb and Gutter O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.43
Machine Operator;Clary
and Similar type of
0 screed Operator 243.18 376.80 231.70 38.15 287.49 1,177.32 2,257.50
S 2.00 8.00 8.00 0.00 5.00 0.00 0.00 23.00 :$72:4:3
FERNANDEZ,RAYMOND Laborer and Related
Classifications/Group 1 O 0.00 2.00 2.50 0.00 0.00 0.00 0.00 4.50 $91.38 $3,188.81
0 238.49 541.42 231.73 37.41 71.27 1,120.32 2,068.49
S 8.00 8.00 8.00 8.00 8.00 0.00 0.00 40.00 $69.44
$3,188.81
FRANCO GARDUNO,RAUL Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $141.78
0 230.02 375.35 220.41 36.08 0.00 861.86 2,144.99
S 0.00 0.00 0.00 0.00 2.00 0.00 0.00 2.00 $70.89
$3,006.85
FRANCO GARDUNO,RAUL Cement Mason/Cement
Mason,curt and Gutter O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $95.63 $1,698.99
Machine Operator;Clary
and Similar type of
0 screed Operator 230.02 375.35 220.41 36.08 0.00 861.86 2,144.99
S 0.00 8.00 8.00 0.00 6.00 0.00 0.00 22.00 $72.88
$3,006.85
HERNANDEZ,RICARDO Cement Mason/Cement
Mason,Curt and Gutter O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $93.85 $1,231.45
Machine Operator;Clary
and Similar type of
0 screed operator 174.16 409.58 142.55 27.32 91.94 845.55 1,491.66
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $71.10
$2,337.21
LOPEZ REYNOSO,JOSE DEJESUS Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $24.75 $960.82
0 216.93 264.93 199.75 34.03 154.61 870.25 2,120.05
S 0.00 0.00 0.00 8.00 6.00 0.00 0.00 14.00 $68.63
$2,990.30
LOPEZ REYNOSO,JOSE DEJESUS Operating Engineer/
Group O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $30.97 $184.52
0 216.93 264.93 199.75 34.03 154.61 870.25 2,120.05
S 0.00 0.00 0.00 0.00 2.00 0.00 0.00 2.00 $92.26
$2,990.30
MONTES SR.,ORLANDO Cement Mason/Cement $1,226.16
Mason,Curb and Gutter Machine Operator;Clary O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $93.54
and Similar type of
0 screed Operator 211.63 213.88 176.91 33.20 241.21 876.83 2,000.55
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $70.79
$2,877.38
Page 3 of 6
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9)
z" Tue Wed Thu Fri I Sat Sun DEDUCTIONS
00 Mon
NAME AND INDIVIDUAL I NET WAGES
0 06/23 06/24 06/25 06/26 06/27 06/28 06/29 WITH- TOTAL
IDENTIFYING NUMBER 3i w PAID FOR
FICA HOLDING STATE LOCAL OTHER DEDUC-
(e.g.,LAST FOUR DIGITS OF SOCIAL o w WORK TOTAL RATE OF PAY GROSS AMOUNT TAX TAX TAX TIONS WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED
MONTES,ORLANDO Laborer and Related
Classifications/Group 1 O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $91.38 $1,202.42
0 191.35 393.53 168.69 30.02 28.15 811.74 1,717.72
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $69.44
$2,529.46
PADILLA,HECTOR Cement Mason/Cement $1,261.71
Mason,Curb and Gutter O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $95.63
Machine Operator;Clary
and Similar type of
0 screed operator 206.81 233.75 121.07 32.44 0.00 594.07 2,109.32
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $72.88
$2,703.39
RAMIREZ ARANDA,ROBERTO Operating Engineer/
Group 6 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $94.41
0 229.08 249.73 149.16 35.93 105.36 769.26 2,263.10
S 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $94.41
$3,032.36
RAMIREZ ARANDA,ROBERTO Cement Mason/Cement $1,771.87
Mason,Curb and Gutter Machine Operator;Clary O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $95.63
and Similar type of
0 screed operator 229.08 249.73 149.16 35.93 105.36 769.26 2,263.10
S 0.00 8.00 8.00 0.00 7.00 0.00 0.00 23.00 $72.88
$3,032.36
RAMIREZ,JUAN Cement Mason/Cement
Mason,Curb and Clary O 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $94.18 $1,237.06
Machine Operator;;Clary
and Similar type of
0 screed operator 218.48 478.63 208.12 34.27 156.45 1,095.95 1,845.48
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $71.43
$2,941.43
ROMO,ARMANDO CARDONA Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $2,197.59
0 233.19 348.08 154.65 36.58 0.00 772.50 2,275.77
S 8.00 4.00 4.00 8.00 7.00 0.00 0.00 31.00 $70.89
$3,048.27
ROMO,ARMANDO CARDONA Operating Engineer/
Group 8 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $33.23 $850.68
0 233.19 348.08 154.65 36.58 0.00 772.50 2,275.77
S 0.00 4.00 4.00 0.00 1.00 0.00 0.00 9.00 $94.52
$3,048.27
SALAZAR,MODESTO Laborer and Related
Classifications/Group 1 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $27.01 $567.12
0 226.49 417.22 145.69 35.53 18.36 843.29 2,135.70
S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $70.89
$2,978.99
Page 4 of 6
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
(1) (2) (3) (4)DAY AND DATE (5) (6) (7) (9)
(s)
z Mon Tue I Wed I Thu I Fri I Sat I Sun DEDUCTIONS
og rc
NAME AND INDIVIDUAL 0 NET WAGES
0 06123 06124 06125 06126 06127 06128 06129 WITH- TOTAL
IDENTIFYING NUMBER w PAID FOR
(e.g.,LAST FOUR DIGITS OF SOCIAL p w WORK TOTAL RATE OF PAY GROSS AMOUNT FICA HOLDING STATE LOCAL OTHER DEDUC- WEEK
SECURITY NUMBER)OF WORKER z CLASSIFICATION HOURS WORKED EACH DAY HOURS EARNED TAX TAX TAX TIONS
SALAZAR,MODESTO Cement Mason/Cement Z$1,261.715619 Mason,curb and Gutter O 0.00 1.00 0.00 0.000.00 0.00 0.00 1.00 $95.63Machine Operator;Claryand Similar type of
0 screed Operator 226.49 417.22 145.69 35.53 18.36 843.29 2,135.70
S 0.008.00 8.00 0.00 0.00 0.00 0.00 16.00 $72.88
VEGA,RUTILIO Laborer and Related
Classifications/Group 1 O 0.00 0.00 1.50 0.00 0.00 0.00 0.00 1.50 $89.06 $133.59
0 229.44 532.88 219.63 35.99 177.15 1,195.09 1,874.46
S 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $67.12
069.55$3,
VEGA,RUTILIO Cement Mason/Cement
Mason,curb and Gutter O 0.00 1.50 0.00 0.00 0.00 0.00 0.00 1.50 $91.86 $1,243.55
Machine Operator;Clary
and Similar type of
0 screed Operator 229.44 532.88 219.63 35.99 177.15 1,195.09 1,874.46
S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 $69.11
$3,069.55
While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a).The Copeland Act(40
U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week."U.S.Department of Labor(DOL)regulations at 29 C.F.R
§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or
mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Public Burden Statement
We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.If you have any
comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W.Washington,D.C.20210
(over)
Page 5 of 6
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA Sidewalk Improvement/20250580287
Date: 7/15/2025 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
I Panagiotis Leonida PRESIDENT rx-1— Each laborer or mechanic listed in the above referenced payroll has been paid,
(Name of Signatory Party) (Title) 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
do hereby state: the contract,except as noted in section 4(c)below.
(1)That I pay or supervise the payment of the persons employed by
Leonida Builders Inc on the (c) EXCEPTIONS
(Contractor or Subcontractor)
City of Lake Elsinore-CDBG/SB 821 Lakeshore Drive ADA EXCEPTION(CRAFT) EXPLANATION
Sidewalk Improvement ; that during the payroll period commencing on the
(Building or Work) Training. Training paid to California Apprenticeship Council.
23 day of June 2025 and ending the 29 day of June 2025
all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or
will be made either directly or indirectly to or on behalf of said
Leonida Builders Inc from the full
(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.967;76 Stat.357;40 U.S.C.§3145),and described below:
Permissible Deductions:
REMARKS: Deductions may include pre-taxed medical,dental,vision,and/or cash
fringes,pre-taxed 401 k contributions and/or court ordered garnishments.
(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
Bureau of Apprenticeship and Training,United States Department of Labor. NAME AND TITLE SIGNATURE
(4)That: Panagiotis Leonida, PRESIDENT Pa4ia o'Lem
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY
�— in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL
referenced payroll,payments of fringe benefits as listed in the contract have been or will be PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31
made to appropriate programs for the benefit of such employees,except as noted in section 4 OF THE UNITED STATES CODE.
(c)below.
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