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HomeMy WebLinkAboutSANTAROSSA MOSAIC *=& TILE CO.,- 001356- 11/18/2010 CARMEL REDEVELOPMENT COMMISSION 001356 Santarossa Mosaic & Tile Co., Check: 1356 2707 Roosevelt Avenue Date: 11/18/2010 Indianapolis, In 46218 Vendor: SANTAROI Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 11 57 128,543.08 128,543.08 0.00 0.00 128;543.08 Application 11 128,543.08 128,543:08 0.00 0.00 128,543.08 PreeNattfalSORSTHIS CHEC KHAVA?COLOREDPDACKGROUNDIAND!CONTAINS!MULTIRLESECURITY:FEATURES'd SEEIBACK FOR!DETAILS<!NINCSGIMWMI9t ..<*6OEs,0 Carmel Redevelopment Commission -0 013 56 , l , 30 West Main Street �i REGIONS �� Suite.220 zo-Iazlnao• tit Carmel, IN 46032 - .. not- 1356. ' DATE - AMOUNT 11/18/2010 ""`*****128,543.08 ITddE SUM OF ONE HUNDRED TWENTY EIGHT THOUSAND FIVE HUNDRED FORTY THREEDOLLARS AND 08 CENT TO THE ORDER ' - . OF Santarossa Mosaic &Tile Co., 2707 Roosevelt Avenue >`sE"s'- • • - Indianapolis, In 46218 '1a 11100i356ii• 1:0740i42L31: 0087504LIle CARMEL REDEVELOPMENT COMMISSION 001356 Santarossa Mosaic&Tile Co., Check: 1356 2707 Roosevelt Avenue Date: 11/18/2010 Indianapolis, In 46218 Vendor: SANTARO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 11 57 128,543.08 128,543.08 0.00 0.00 128,543.08 Application 11 128,543.08 128,543.08 0.00 0.00 128,543.08 • C T ® - =�lA Document G702/CMa TM — 1992 57 Application and Certificate for Payment Construction Manager-Adviser Edition TOOWNER:e/�Ijc? �� ,yvp�,,JeLg7 amity PROJEcnehemo ,Q( 1 APPLICATION NO: ` I Distribution to: l{ ;` �IViI��P`^(rVQrI�1Q�yQ$$ pEJCdK JQIl1a�S�Q2tQg551r o PERIOD io: �110 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: (}�CI J MSii a VIA CONSTRUCTION MANAGER: CONTRACT DATE: U51PI,l t ARCHITECT ❑ IUD 1 PROJECT NOS: (�zQI I CONTRACTOR ❑ tOM po rifles VIAARCHITECT: FIELD ❑ oopails,Tn CONTRACT FOR VIM .e, bnagelt Ilk ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment.as shown below.in connection with the Contract. belief the Work covered by this Application fur Payment has been completed in accordance with the Continuation Sheet,AIA Document 0703,is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certilicatcs for Payment were issued and payments received from the Owner and that current 1.ORIGINAL CONTRACT SUM S MI p 45r).to payment shown here n is n w dby;. 2.Net change by Change Orders $ I CONTRA TOR: a l em ocale ell 10,01. C. 3.CONTRACT SUM TO DATE(Line-I +,2) ........... ...............................$ME a By: *ad ,/ . �� Date: 41 110 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ i SCI , t State or IID 5.RETAINAGE: County of:frbf n a %of Completed Work { Subscribed and ore to before (Column of Stored S �7. 22,r1� Neary ubli .. b """�o of Scored f,9 aterka3 Notary Publi (Column F on 0703) $ My Coombs. t c r s:I S 13- . Total Relainage(Lines 5a+Sb or Total in Column I of G703).. $ 49 .7;29.5) CERTIFICAT FOR PAYMENT t . . ID 1 r 2012- In accordance with the Contract Documents. based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE S lk this application the Construction Manager and Architect certify to the Oviner that to the best of their One 4 Less Line 5 Total) n� knowledge. information and belief the Work has progressed as indicated,the quality of the Work is in 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ b44 b17. Q4- accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) p CERTIFIED. R C.s coS 8.CURRENT PAYMENT DUE.._._... ............................................. I $ (22,54S. D5 AMOUNT CERTIFIED S lzB,5 5 9.BALANCE TO FINISH,INCLUDING RETAINAGE` (Attach elplanatian f amount certified differs from the amoiorrapplied. Initial all figures nn this 2 Application and an the Conrb:Hatton Sheet rhr r humped to antra;nr with the amount certified.) (Line 3 less Line 6) s I?'/$2 42 CONS •UCTION •� GA; j By: ,r'.._i _... .t.._. Date: 7)9 24110 ig. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ' ARCM "� � Total changes spproved in previous months by Owner $ $ By: .ill i , - Date: tl III Total approved this Month $ $ This Certificate is not negotiable The AMOUNT CERTIFIED is payable only 0 the Contractor TOTALS $ $ named herein Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. CAUTION:You should sign an original MA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. NA Document G702ICMalm-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAa Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAe Document,or any portion of II,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. . Purchasers are permited to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,cepyright@aia.org. �+ 09201 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverseside) n;F 2 OF '—voters AlA Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification, is attached, APPLICATION DATE: 9115/2010 In tabulations below amounts arc stated to the nearest ©odor PERIOI) TO: 9/23/2010 Use Column I on Contracts where variable retainage For line items may apply ARCHITECT'S PROJECT NO,: A R c 1) E F G H I WORK COMPLETED MATERIALS 'IOIAI. 5CHEDULE2 COMPLETED HALANCE ITEM PRESENTLI' T.O RETAINAGE NO DESCRIPTION OF WORK FROM PREVIOUS STORED AND STORED (IF VARIABLE v41.UF. APPLICATION THIS PERIOD (NOT 1N TO DATE 1G - C) FINISH RATE)VARIABLE) ID i E) I) OR E) (U+E+r) (C - G) 111.001 STONE FLOORING OLIO( MATERIAL 407,325.00 407,325.00 402,525.00 100 38,51510 01.201 LABOR 549,950.00 142,277.54 128,543.08 270,820.62 77 79,129.38 1,786.65 01.301 01.40( STONE TOPS 01.500 MATERIAL 20,000.00 20,000.00 )0,000.00 100 1,000.00 1 01.600 LABOR 28,000.00 14,065,00 14,065-00 50 13,935.00' 703.25 01.700 01.800 QUARRY TILE 01.900 MATERIAL 1,500.00 1,500.00 02.000 LABOR 1._500.00 500.00 02.101 02.101 GENERAL ALLOWANCE 35,000,00 4,557.00 4,557.00 13 305443,00 02.301 CAD AS-BUILT ALLOWANCE 5,000.00 5,000.00 03.401 BOND 3,175.00 3,175.00 3,175.00 100 317.50 03.591 03.601 CHANGE ORDER#1 03.701 846,450.00 586,399.54 128,543.08 714,942.62 84 131,507.31 42,322.50 a�'1ly�laammlryar AIA DOCUMENT G703•CONTINI AEION SHEET FOR 07(12 • 1992 POTTION' • AFAR • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORE . a9�• AVENUE,M3V,WVtSHINCTOF.00.?e006.5293•WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. G703-1992 CAUTION:You should use an original AIA document which has this caution printed in red.An original assures that changes will not be obscured as may occur when documents are reproduced. Monthly.Employment Utflfzagoo Report U,S. Department of Labor Empl¢ymenl Siondardi Administration Il nlr re o y, 011lca el Feddrkl Canlied Compliance Pr¢grams �� , being eonr l rc urrrmineied afuimp+°deei in 24 Sec In part and the cootnetnr mar halt coneredtr rneliglbie or runner Government contract,a! redueOf a:rtrled cpnrlmction contract.. I. Cayerad Area(5AI§A Cr EAI 2, Errployen1D.GNn�,,/)� OMB Na N rZ13q IR] 3. Curren?fears e, lloporl tip Perini' mnaLe ¢i di CanVe r _ .35_09.4 f 0 c.p �Eeplror: 12/31,31 I.11norIy _ Fromryp� �a�IIIO �`?,7�,I�I`Q �yy��-``QQ����Fw�n jZ��''((((//��{{ I rl[�.f?p�L-F[�. �f �J I//I Fedar¢IFUedlnp Ayaney(List alit Female _ To lf"I1 'IIiV {I�(.1 1d �� r0 �C� C-� {'- - - 5. E. TOTAL.FEDERAL b FlON•FEiIER,(L CON Sri-MOTION WORE HOURS Ea. Eh. 9. 1U. CONSTRUCTION Bo. Bd- Ee. 7, A TRADE Clessllicalipnl Total AR Meek - Allan or American:. Tod! Employees fNo[al HI[ enlr Tniel odly sr p P¢Illt Indian or i Number of of kllnarlly �r� Ailnarlly Female Employaaa Enplgyee>r By Trade Dllpint Hispanic Islander Alesken Hallve I W� Journey Worker! rFi F. N F _ RI F © F Portman Pereeni pe _ 11 v Appreellc¢ a, r r 0 d F 1 Trainee a- — © ..... � , � < V U i f U t -a-.. - L. e �I r a �•- -e- .3eiV e-5 S __ ! IC 5 c • .A Jo-tiro ay Worker i Apprensln - � W N Tral nee ---- Journey Worker • a AppranHga plillill.______ Jcurney Worker Appra nil ne � Tr¢Ine• • Journey Mforker .. �. Tnlnee la •.� -® �I�� I Total Jgvrrtay Work ere 8 (. . a .� G In f -e-- Talel App7eellcea tie c � - c . -- a_ 4 4 c Tale! Tnlnaes -8-. - - .0 t 6 Jf '{�f O�h /0 -� 0 6 "!"r/J !I r ..E- c' o 8- afend Total U« -A LA Ca _E :,- `'J Q I f. Company Orrlcie l's Slpnelure end hue - - - - j •b -e 12. Tefo ton¢Nurrther 13. ale Signed (Include*rat coda) Pe,ie i , t1�L f-g_ - (311 D32- Y4 "I+ OI , I) ! nl g Form Cc-257 nevi Dec. 1402 • • Santsrosse Massie a Tile Co. Inc. Certified Payroll Report 09-21-2010 ?age 1 System Dace: 09-21-2010 System 9'Ine: 8,k3 as Files tired: MASTER,.C21 MASTER,PRI SlSTE11.FP.S CURRENT,ORT For the Period Ending 08-29-10 AWL 09-201 CAPi0L PAC 591EL SE%TON ARTHUR O'JCN:EI:E, JR 22811 SR TA CiCERO, iN 46834 08-23 08-24 08-25 08-25 08-27 D8-29 08-29 701281 Ce611 F.fly cross Total FNH 5'711. Other 311-60-5761 Caucasian Hale Non Tee Wed Thu Fri Sat Sun Hours Pale Fringe Fringe This Job Gross FICA SUIISDI Deducts Net - 0 leg 9.00 9.00 2.00 2.00 20.00 330.93 610.60 616.60 91.00 20.28 50.07 148,01 610.00 17.16 San taros50 Hosaic 4 Tile Co. Inc certified Payroll Report 09-20-2010 Page 2 System Date: 09-21-2010 System Time-: I;!] a. Files Used: MF.STER.3CH MASTER.PRM S YS TESI.PRS CURRE,\\2T.OPT For Cho Perood Ending; 00-29-10 Joh: 09-201 CARMEL PAC SHLSL SEXTON MARK 013009MI 3880 Mohr RU Greenfield, IN 41140 00-23 00-24 08-25 OP-24 08-27 08-28 06-29 Total Mash Arly Cross Total il€H SdH Other 310-'l0-6220 Caucasian Male Men Tue Wed Thu Fri Sat Sun Hours Rate Fri Nye Fringe This Job Gross FICA SBi/SOS Deducts leer 5 - 2 Keg 6.00 8.00 10.00 31.37 501.92 1,254.80 195.43 41.31 142.92 779,07 501,92 5.99 KEVIN uuSOCKl 301 E. 2ND STREET SHERIDAN, IN 40069 08-23 08-24 00-25 96-22 08-27 08-26 09-29 Total Cash sri Gross Total 61017 S'SUE Other Gs 306-6E-1759 Caucasian Male oy Tue I0.0 0.0 Sat Rita H 40,0 0.40 Fringe Fringe This 325 210.2 29.1 5UI/30I 1eC1es get y -10 Reg B�OU 0.00 9.00 E.OC 6.00 40.00 40.46 1,214.20 1,210.20 93.20 34,p1 1'/8.04 87].80 1,214.20 93.2: JUN HERNANDE2 2411 E. KELLY ST. INDIANAPOLIS. 914 46203 04-23 08-24 00-25 00-26 06-27 06-26 08-29 Total Cash 14:71.6 Gross Total MR awl Other 313-90-1830 Hispanic Male Mon les sec Thu Fri Sat Sun Hours Rat. Cringe uringe This Job Gross FICA nor/nor Deducts Nei +. - 2 Req 0.00 8.00 16.00 19.86 217.79 794.40 05.74 29.03 43.31 596.56 217.76 61.76 PEDRO E IlERRERAA 8509 SWEET 6IRC11 DRIVE INDPLS., IN 46239 08-23 03-24 00-25 08-26 08-27 09-28 08-29 ToLa! Cash Hrly Gross Total 175111 04tH Other 603-19-2546 Hispanic Hale Mori Toe iced Thu Fri Sat Sun Hours Rat. Fringe Fringe 2111s t 1s Job Gross FICA SUI/501 Deducts Ne H - 4 Reg 8.00 9.00 8.00 8.00 8.00 40 00 20.06 802.90 802.40 29.63 24.07 43.01 832.94 802.90 61.39 ROBERT H!XYS'TE'rCB'i 4320 NT-GHOL AVE ANDERSON, IN 46011 08-23 08-24 06-25 08-26 08-27 08-28 09-29 Tcta'- Cesh Hrly Gross Total NNE MCA Other 314-84-0064 Caucasian Hale HOn 'Jed Thu Fri Sat Sun Fours late Friuge Fringe This Job Gross FICA S0I/SDI Deducts Net N - o Req 0.00 9,00 9.00 8.00 9.00 40.00 31.16 1,246.40 1,246,90 65.37 38.45 62.73 964.10 1,246.40 95.35 J USTIN KOT'IERMAN 1075 W. COUNTY RD 125 SOUTH CENTER POINT. IN 47540 00-23 0E-24 08-25 06-20 09-27 08-2E 00-29 Total Cash Hrly Gross To;e1 96/H Stole Other 310-82-7402 Caucasian Male Mon rue Wed Thu Fri Sat Sun Hours Rate Fringe Fringe This Jon Grose 2162 5UI/3DI Deducts Net H - 1 Reg 3.50 3,50 20.60 72.10 634.30 700.20 27.71 42.21 024.32 72.10 63.82 PETER A LAIJDADIt 9356 EAST 82 NO PLACE INDIANAPOLIS, IN 46254 08-23 08-29 08-25 06-26 08-27 08-29 08-29 Total Cash Hrly Gross Torsi FAH 6193 Other 303-58-0137 Caucasian Mole For TV. 'Wed Thu Fri Sat Sun Hours Rate Fringe Fringe This Jon Cross FICA 501/541 Deducts Net 5 - 2 Req 8.00 8.00 16.00 22.07 352.12 960.73 96.91 27_96 49.25 623,7.7 252.12 55.89 MARCOS LOPEZ 2049 PHENIE. STREET FORT 'a AYNE, IN 16802 08-23 08-24 08-25 00-26 00-27 00-2B 08-29 Total Cast Hrly Gross Total FAH DNB Other 313-06-8467 Iltspantn Male Tee used Thu Fri Sat Hun SOUS''. Rate !tinge Fringe This Job Gross FICA 5UI/5DI Deducts Net 5 - 1 Reg 8.00 8.00 16.00 20.55 488.80 1,222.00 204.76 40,69 660.01 823_84 499.90 92.49 BMrHOLOMZW K MAY5 P.o. 300 253 DUBLIN, IN 47333 08-23 08-24 08-25 06-26 08-27 08-20 08-29 Total Cush Hedy G-CSs Total FWH SHE Other 312-96-2190 Caucasian Male Non Tue Wed The Fri Sat Olin 6 lours Rate Fringe Fringe This Job Gross FICA 501/5DI Deducts Nat 5 - 2 Reg 8.00 8.00 8.00 8.00 8.00 40.00 20.27 810.00 410.00 35.4'1 26.26 71.95 559.10 822.90 62.02 305.IN L. 611161CII, 8397 FOLAMO ROAD GRRH625F0RH, 2N 47245 08-23 06-24 08-25 08-26 06-27 08-29 08-29 Total Cash Hrly Gross Total FOP SHH Other 311-06-5892 Caucasian Vale Non Toe Wed Thu Fr: Sat Sun Hours Rate Fringe Cringe This Job Gress FICA SUI/SDI Deducts Net M - 9 Fed 9.00 6.00 9.00 8.00 8,00 10.00 16.87 474.00 679.60 24. 3 20,23 31,$5 542.50 674.00 51.663 v6cToa PTN:C09. 5026 SHADOW POINTE DRIVE INDIANAPOLIS, IN 46254 00-23 08-24 08-25 08-26 00-27 09-28 06-29 Total Cosh Hrlc Gross Total FFII SUN Other 529-20-3834 Hispanic sale Non Tue Merl inn Fri Sat sun Sours Rate Fringe Fringe This Joh - FTCR 501/501 Deducts Net • - 0 Reg 2.00 0.00 8.00 0.00 0.00 00,00 18.68 747.20 747.20 17.22 21,40 20.87 611.46 747.20 57.17 8RANDON srRAIr PC BOW 432 DUBLIN, IM 47335 06-23 CA-24 CB-25 09-20 06-27 00-28 00-29 To Cal :ash F.rly Gross Total FBI[ 5::11 Other 208-96-2679 Cautasan male Hon toe 'Nod Thu F:'1 Set Sun Hours Rate Ietnre Fringe This Job Gross FICI.5UI/5DI Deducts Net S - 1 Reg 6.00 0.00 0.00 9.00 6.00 40.00 79.18 1.197.20 1,167.20 171.03 09.03 63,42 714,37 1,167,20 87.29 Ul0001)35 J. IquILL.oCE 2216 C, THOMPSON RD. INDIANAPOLIS. IN 46229 08-23 09-21 09-20 09-20 0B-27 09-29 08-29 Total Cash Hrly Gross Total FIVE 591H Other 307-02-1123 Caucasian ]:ale Men Toe Wed Thu Fri Sat Sun Hours Rale Fringe leringe Thus Job Grass FICA 501/541 Deducts Net ▪ - 2 Reg 3,54 3.50 20.20 70.70 018.10 26.50 24.51 39,39 603.01 70.70 52.50 Santacossa Nosait 6 Tile Co, Inc. Certified Payroll Repore 09-21-2LC0 Page 3 System Date', 0P-21-2010 System Tice; 8'13 d Files Used; lCSTER.ICC P,1STER.PPIC S VSTE14.PPS CURRENT.PPT For the Period Fridley. 04-05-10 Fort 09-201 CARI:EL PAC 89E57 sexroN meNPETH '0I51054T F.Ct LOX 311 IHGALLS, IF 45043 00-23 08-24 08-25 05-2O 05-27 08-20 08-29 Total Cash Tidy Gross Total F411 5545 Other 105-50-4063 Caucasian Nate Non _ red Thu Fri Sat Sun hours Rate Fringe Fringe 'This Job Gross FICA G011051 Oeducus Set 5 - 0 Reg 8.00 8,00 8,00 9.00 6.00 40,00 21.44 057.60 859.40 131.23 25.16 120.49 407.01 957,60 25.61 Totals for Calu4EL PAC 00-23-10 00-24-10 03-25-10 08-26-10 05-27-10 08-25-10 08-29-10 Total Gross Total No0ddy Tuesday ,,eJ n esdy Sbeinlay Friday Saturday Sunday hour's lots Job Gross DecuctlOns' Set 5 104.00 50.00 19.00 66.00 5.00 .00 00 411.00 9,946.60 19,925.53 FAH 1,390.10 9,553.885 FICA 1,065.77 SWF. 457.01 SDI _00 Otbwr 1,060.15 Sant'arossa Mosaic d Tile CO, IIc. CeriiLied Payroll Deport 09-21-2010 Page 4 System Hate 09-21-2010 • System Tine' 8111 am Files RiacS' HASTER.JC1 MASFER.PR2 Si5IEH.PRS CURREST.PRT For the Period Ending: 09-05-10 Job, 09-201 CARMEL PAC 501£5 SEXTON ANUSES AGU]LERA 2402 0, FISHER RD. INIDAMAPOIls, IN 40239 06-20 06-11 09-01 09-02 09-03 05-04 09-05 Total Cash so-ly Gross Total full SW1 Other 306-84-4409 Hispanic Male Mon Cue Ned Thu Fri Sat mm flours Rate Fringe Fringe This Job Gross FICA 5UI4501 Deducts Not M - 0 Reg 8.00 8.00 16.00 24.92 398.72 996.60 LII.11 33.89 53.31 322.19 390.72 75.25 0Hd1ST09 18 COLLINS 3452 N. ARLINGTON AVE. INDIANAPOLIS, IN 46211 08-30 08-31 09-01 09-02 09-03 09-04 09-05 Total Ca9H arty Gass Total AiH 51H Other 116-68-9520 Caucasian wale Non The Wed Thu Fri Sat Sun Hours Rate Fringe Fringe This Jcb Gross [DCA SCI;SDI Deducts Net 5 - 5 Rea_ 4.00 3.00 7.00 18.86 110.16 185.58 15.00 2.19 65.52 90.61 1.8.16 12.30 ARTHUR DLCHESE, JR 22811 SR 19 CICERO. IN 46034 06-30 08-31 09-01 09-02 09-01 09-04 09-95 Total Cash 14216 Gross Total RAH CWH Other 317-60-5763 Caucasian Sale Mon Tue We2 Thy Fri sac Suit Hours Rate Fringe Fr1n49 This Job Gross PICA 501/501 Deducts Net 7e4 8.00 8.00 0,00 8.00 8.00 40.00 30.83 1,233.20 1,233.20 140.53 40.57 100.12 857.10 1.233.20 94.14 KEVIN GOBOCH_ 301 E. 200 STREET SHERIDAN, IN 46069 06-30 09-31 09-01 09-02 09-03 09-04 09-05 Total Cash rely Gross Total FW11 5'1113 Other 300-66-1754 Caucasian Male Mon Tue 'Bed Tlm Fri Sat Sun Hours Rate Fringe Fringe This Joh Gross FICA SUI/SDI Deducts Net K -10 Reg 0.00 6.00 6.00 1.00 8.00 40.00 10.98 1,219.20 2,219.20 39.10 34.91 1/9.04 673.00 1,219.20 93.27 IBAN HERINANDEZ 2413 E. KELLY ST. INDIANAPOLIS, IN 80203 06-10 08-51 09-01 09-02 09-01 03-04 09-05 Total Cash Hrly Gross Total 8W11 59111 Other 313-90-1830 Hispanic Male Mon Tne Wed Ihu Fri Oar Sun Hours Rate Fringe Fringe This Job Gross FICA SUI/SDI Deducts Net M - 2 Feg 4.00 0,00 6.00 8.00 0.00 26.00 19.06 714.16 794.40 05.74 20.03 43.31 591.55 '14.92 60,77 PEDRO 11 HERRERA 8509 SHEET BIRCH DRIVE I20PL5., IN 46239 09-30 08-32 09-01 09-02 09-03 09-04 09-05 Total Cash Hrly Gross Total FFH S'E0 Ocher 603-19-2946 Hispanic Male Hon Tue Wed The Fri Sal Sun Hours Rata Fringe Fringe This Soh Crass FICA 1OI/50] Deducts Net M - 4 Reg 8.00 8.00 9.00 8.00 0.00 40.00 20.06 802.40 602.40 39.13 24.67 43.97 433.45 802.40 61.98 CARL HE5TAND 204 MOORLLAND DRIVE NEW f4HT TE_ANO, I9 45191 08-30 08-31 09-01 09-02 09-03 09-01 09-05 Total Cash H1y Gross Total F.13 940 Ocher 303-72-2469 Caucasian Yale Mnn 'tee Wed Thll Fri Sat She Hours Rate Fringe Fringe This ioh Cross FICA 901/901 Deducts Net I! - 0 Reg 6.00 0.00 29.94 238.72 1,193.60 140.63 40.56 59.06 962.03 238.72 91.30 ROBERT HOCKSTITIER 4320 NICHOL AVE. ANDERSON, IN 4E011 08-30 08-31 09-01 09-03 B9 03 09_04 09-05 Tote] Cash Half, Gross Total PNH HER Other 311-04-0064 Caucasian !ale Hon Tue Wed Thu Sat Sim SOIL; Rote Fringe Fringe This Job FICA 0UI/SDI Deducts Net Fri Gross 1! - v Reg 0.00 8.00 9.00 9.10 5.00 40.00 31.16 1,246.40 1,295$90 85.37 39.95 fi?.T"u 964.50 1,246.40 95.x5 P0100 A 1„0,IIDADIO 8356 EAST 62 ND PLACE INDLWS-POLIS. III 46250 05-30 08-31 09-01 09-02 09-03 09-04 09-05 Total Co'.al, Ht'12 Gross Total 3740 SOH Other 303-58-0137 Caucasian [tale Non Tie Wed Thu Fri Sat Sun Rove Fringe Fringe Tlda Job FICA SDI/SBI Deducts Net 5 - 2 Reg 0.00 3.00 5.00 v 21`00 22.03 529.68 920.96 113.47 30.21 49.50 662.67 Reg 5.00 5.00 29.83 124.15 653.63 10.01 MtRCOS LOPS' 2049 PH0NIE STREET FOOT WAFil , 10 44812 03-30 03-31 U9-01 09-02 09-03 09-04 09-05 rota! Cash lirly Cross Total FEE! 35H Other 313-06-8987 Hi :side Bale Mon Tue Wed Thu Fri Sat Sun Hours Race Fringe Fringe This Job 1110... 17CA s01/501 Deducts Net a - - Reg_ 9.00 0.00 30.58 244.40 1,22200 204.08 40.99 60.01 822.94 244.40 93,18 DN]LEL NAYS 3900 WEST OLD RRCHNSVILLE RD. LIBERTY, IN 47353 00-30 00-31 09_01 09-02 09-0S 09-04 49-05 Tots1 Cosh Hriy Cross Poral FwM SON Other 306-46-0155 Caucasian Male Ion Toe Wed Thu Fri Sat Sun Hours Rare Fringe Fringe This Job Grose FICA 501/501 Deducts Yet N - 0 Peg 8.00 8.00 23.92 191.30 956.60 105.11 32.53 50.03 095.91 101.36 73.19 EARTHOLOY.E'A K MAYS T.O. NOR 253 'UNL]N, IN 47135 08-30 02-31 09-01 00-02 09-03 09-04 09-05 Total Cash Hrly Gross Total FAH 59M Ocher 303-96-2109 Caucasian Male Hen Toe End Thu Fr! Sat Hon 800ri Rate Fringe Fringe Th15 Joh Gross FICA S1I/S0I Deducts Net 5 - 2 Reg 9.00 8.00 8.00 6.00 8.00 40.00 20.27 810_60 610.60 65.47 26.15 77.95 559.09 810.00 62.03 MATINEE S. SIFFORD 1010 N. ^GTR 9TRFeT RIcm4o13.D, IN 47374 08-30 08-31 09-11 09-02 09-03 09-01 09-05 Total Cash Hr Ly Gross Total F441 SWH Other 520-02-5810 Caucasian Male ,or. Tue Wed The Sat Sun Hoot/ Rote 2ri59e Fringe Ti,I a .; Gross FICA. 500/5DI Deducts Net Tel doh Rey 6.00 8.00 15.50 124.00 6£0.00 15.50 22.89 503.18 124.00 43.43 Santarossa Musalc s Tile Co, Inc, Certified Payroll Report 09-21-2010 Page 5 System Date', 09-21-2010 System Time: 8:13 au riles Need: MASTER.JCM MASTES.PPH SYSTEM.PBS C OP RENT.PP1' For the Period Fading OX-05-10 J ob, 08-201 CARTEL PAC 0H1EL SEXTON J USTIN L. RUDICIL 0397 1055340 ROAD G1EEISFORK, IN 97345 05-30 08-31 09-01 00-02 09-53 09-U4 D9-05 Total Cash Hely 612055 roteI F13 GBH Other 311-06-5992 Caucasian Male Hon Toe Wed Thu Fri Sat Sun Hours Rate Fringe Forego Th16 4O4 74 FICA 50]/SDI Deducts Net M - 4 Reg 8.00 3.00 0.00 9.00 8.00 40.00 16.87 674.00 67e.8 0 59.42 30.33 16.29 542,54 6073.80 59.42 VICTOR 27)N4'07A 5025 9PAD041 PGINTC 0RavE INDIANAPOLIS, IN 46254 08-10 88-31 03-01 00-02 09-03 09-04 09-05 Total Cash Hely Grose, 79:81 FtH 8019 0uoer 639-20-3894 Hispanic Gale rue Red Thu Fri Sat Stu Hours Rate Fringe Fridge aus NPl) Gross FICA 807/80I Deducts Net v. - 6 Reg 800 8.00 8.00 6.00 32.00 18.89 597.76 597.76 2.28 13.40 21.52 901.23 597.76 45.73 B RANDON STRAIT PO 303 332 DUBLIN, IN 47335 08-30 08-31 09-01 09-02 00-03 09-04 09-U5 Total Cash 33rly Gross Totn1 i0 5!D Ocher 308-90-2679 caocan8.59 Yale Hon toe 40rs TLU Fri Sat Sun Rate Fringe Fringe This Job Gins: PICA SUE/HOT Deducts Net 1 Reg 8.00 8.00 BeOU 9.O0 8.00 40,90 29,19 1,167.20 1,167_20 189.28 49.03 63.13 994.39 1,167,20 89_29 KENN9111 ''RIGUI P.O. BOX 311 1590115 1Y 46048 08-30 00-31 00-05 09-02 09-03 09-D4 09-05 rota! Cash Hely Gross Total '3:01 0917 OrIes 100-56-4803 010Casian cede Mon Tue wed Thu Fri Sac Sun Fours Rafe Fringe Fringe This Sob Gros; FICA our/SD! Deducts Net a - 0 Reg 6.00 3.00 4.0U 8.00 8.00 38.00 21,44 314.72 014.72 120.51 27.70 132.52 491.664 814_72 82.31 Totals for CAIIMEL PAC 08-30-10 08-21-10 09-01-10 09-02-10 09-03-10 09-04-10 09-05-10 TDtal Gross Total Moniay Tuesday '9ednesdy Thursday friday Saturday Su c nay Barr/ This Jab Gross Deductions Net 76.00 89.00 89.00 104.00 112.00 .00 .00 470.00 15250.63 15,462.72 RIH 1,494.10 11,155.12 FICA. 1,160.97 SOH 503.14 SDI .DU Ocher 1,135.34 Santarossa Mosaic s Tile Co, Ion. Certified Payroll Report 09-21-2010 Page 6 System Dace: 00-21-2010 System Time: 613 am Riles Used: RASTE3.3CM FASTER.M.16 SYSTEM-MS CURRENT.GRT For the Period Ending; 09-12-10 Job: 09-201 CAMEL PAC GRIFL HELTOK ?SORES AGUILER4 2402 5. F1SREd ED. INC!eoA60L ES. IN 46239 09-06 09-07 09-06 09-09 09-10 09-11 09-12 TotaI Cash Nrly Crass ToLet FNH SHE Other 306-64-0469 Hispanic :ale .,on rue Wed Thu Fri Sat Sun Rate Fringe Fringe This Job - i CA SUI/50I Deducts Net Wed Hours .,cuss 11 - 0 Reg 8.00 8.00 0.00 20.00 29.92 596.08 797.44 83.20 27.11 .12-69 525.44 596.06 02.00 CHRISIUPHER COLLINS 3453 N. ARLINGTON AVE. INDIANAPOLIS, IN 46218 09-06 09-09 09-06 09-09 09-10 09-l1 09-12 Total Cash lirly Gross Total 'WH OWH Ot9,er 316-60-9528 Caucasian Hale Hon Tue Fed Thu Fri Sat Sun Hours Rate Fringe Fringe This ,Job Gross 3`-CA 501/8511 Feel/Ott Net 5 - 5 Reg 5.00 5.00 16.56 84.40 540.16 20.32 14.25 06.74 393.44 84.40 39.91 0.90HUR DUCHENE, JR 22811 SR 19 CICERO, IN 46034 09-06 09-01 09-06 09-09 09-10 09-11 09-12 Total Cash Hr'-y Cross Total 25TH 6550 Oche" 317-60-5361 Caucasian Hale Hon Tue Ned Thu Fri Sat Sun Roars Rate Fringe Fringe This Sob Gross _FEIA SV'-/508 ueducts Net 00 - 0 Reg 0.00 5.00 8.00 8.00 32.00 30.03 986.50 966.59 104.31 32.40 90.10 693.75 986.56 75.48 KOVIN 1UHOCRl 301 E. 250 u1loE£1 1116GEDAH, IF 46069 09-05 09-01 09-08 09-09 09-10 09-11 09-12 Total Cash Hriy Gross Total FISH 5'114 other 300-06-7754 Caucasian male Han Tue Wed Thu Fri Sat Sun Hours Rate Fringe Fringe This Job Gross FICA SOT/SOS Deducts Net F -10 Reg 6.00 6.00 8.00 8.00 32.00 30,46 975.36 975.35 11.96 26.62 166.00 696.12 970,36 74.01 J OAN HER:4ANEEt 2113 E. KELLY ST_ INOIANAPOLl S, IN 46203 09-06 09-01 04-00 09-09 09-LO 09-11 09-12 Total Cash Hriy Gross Total ME SWF.. Other 311-90-1630 Hispanic male non due Wed 'Chu Fri Set Sun Hours Rate Prange eetnge This J0b Gross FICA 511E/S0I Deducts Net 2 Reg 0.00 8.00 8.00 8.00 32.00 19.86 635.52 635.52 41.91 22.63 34.52 491.60 635.52 40.52 PEDRO 11 =RENA 8509 SWEET D1RGII DRIVE 1NDPLS., IN 46239 99-06 09-07 09-00 09-09 09-LO 09-11 09-12 Total Cash I[rly Gross Total FM! 5WH Other 601-18-2546 Hispanic Male Mon Tue Wed Thu Fri Sat Sun !lours Rate Fringe Fringe This Job Gross FTC! DUI/uDI Deducts Net 91 - 4 Reg 8.00 6.00 6.00 8.00 32.00 20.06 601.92 641.92 20,73 19.21 34.20 519.6E 601.92 49.10 CARL HE5TRV0 204 M008511ND DRINK NEW RHITEL.AND, IN 46:64 09-06 99-01 09-00 09-09 119-10 09-11 09-12 Total Cash Hnly Gross Total W!H 5'1H Other 305-72-2469 Caucasian Male Mon Tue Wed Thu Fri Sat Sun Hours Rate Fringe Fringe This Joh Gross FCA 501/SDI Deducts Net K - 0 Reg 8.00 8.00 29.84 239.32 954.00 104.82 12.47 47.25 697.29 230.72 1:1.05 RERERT HOC:HSTETLER 4320 N.ICHOL AVE. ANDERSON, IN 45011 09-06 09-57 00-08 09-09 115-Ill 09-i1 09-39 Total Cash Htly Gross Total FNN. 5'4'H Other 314-84-0064 Caucasian Male Mon Tue 'Wed T`-0 Frl Sat Sus Hoer, Rate Fringe Fringe Fhls Joh Gross FTCA SUI/SDI Deducts Net • - 6 Reg 8.00 8,00 8,00 0,011 32,00 31,16 99T in 997.12 4'/.98 29.99 49.89 792.99 997.12 16.29 . JUSTIN XOTTRRMAN 1079 W. COUNTY RD 120 S0UTH CENTER POINT, IN 47940 09-06 09-07 09-011 09-09 09-10 09-11 09-12 Total Cash Hriy Gross Total FUR S':1H Otter 310-92-1402 Caucasian Male Mon Tea fled MU Fri Sat Inn Hours Data Fringe Fringe rills Joh Gross FICA SUP/SDI Deducts Net M - I Reg 8.00 8.00 20.60 164.00 641.90 411.39 21.4: 32.14 497,02 164.90 49.64 MFRCO5 LOPEZ 2049 PBEYIE STREET FORT WAYNE, IN 46802 09-06 09-07 09-09 09-09 09-10 09-11 09-12 Total Cash Hriy Gross Total FNH 51:13 Other 313-06-9067 Hispanic Male Mon Tue 'Wed TOU Fri Sat Sun Hours Pate Fringe 'Fringe This Job Gross FICA SVI/SDI Deducts Net F - 1 Reg 6.00 6.00 6.00 3.00 32.00 39,55 977.60 977.60 142.16 32.00 47.95 679.60 977.60 14.78 BARTHOLOMEW K MAYS P.O. BOX 253 0UBLIN, IF 47335 09-06 09-01 09-08 09-09 03-10 09-11 09-12 Total Cash Erie Cross TL1a1 FISH sr Otter 303-96-2199 Caucasian Hole Hon Toe 'Wed Thu Fri Sat Sun Row's Rate Fringe Fiinye This ,Job Gross PICA 5111/SO5 Oed,Ctn Ne0 5 - Rey 6.00 6.00 8.00 24,00 20.27 486.48 406.45 35.92 55.23 00.53 336.69 486.40 37.21 MATTHEW S. SIFFORD 1010 N. '-6T_ STREET RIC11NOl0O, IF 41374 09-01 09-00 09-08 09-09 09-10 09-11 09-12 Total Cash HELy Gross Total DSH s'AP. other 520-as-59l0 Caucasian Male Hon Tue Ned Thu Fri Sat Sun Hours Bate Fringe Fringe This Job Gross FICA 5115/501 Deducts Net Y. - , Reg 8.00 8,00 6.00 8.00 32.00 15.50 496.00 496.00 12.29 25.91 419.85 496.00 57.95 JUSTIN L. AU0ItIL 8597 FOLANn ROAD OREENSF09k, IF 47345 09-06 09-07 09-08 09-09 09-10 09-11 05-12 Total Cash ]arty Gross Total 5591 59111 Ocher 311-06-5892 Caucasian Male Mon Tile Wed Thu Fri Sot Soo Roars Rate Fringe Fringe Tide sob 0reen FICA SVI/SOT Deducts Net M - 4 Reg 8.00 0.00 6.00 6.00 32.00 16.87 559.84 539.84 10.52 15.09 26.16 043.52 519.84 41.10 San:arossa Mosaic a Tile Co, Inc. Certified Payroll Report 09-21-2010 Page 1 System Date: C9-21-2010 • Systen Time: 8:13 am Files Used: SJSTER,CCN :TASTER,MN SYSTEM,PPS CUPRENT.PM For the Period Ending: 00-12-10 Job: 09-201 CAMEL PAC SNIEL SEXTON VICTOR PANTO-'A 5025 SHADOW POINTE BREVE INDIANAPOLIS, IN 46254 99-04 09-01 09-09 09-09 09-10 09-11 09-La Total Cash Hrly Gross Total Fd'.1 1411 Other 939-20-3894 Histanic Hale Mau Ned Too Sac Sun Hours Rate Fringe Prince This Job Gross FICA SOI/SDI Deducts Net - 6 Reg 3.00 8.00 8.00 0.00 32.00 08.18 597.71 597.1E 2.20 16.40 31.52 501.04 597.71 45.72 B?JO4]CN STPPIT PO BOK 332 DBPILA, IN 47335 09-05 09-03 09-08 09-09 09-10 09-11 09-12 Total Cas.^. 1151•; Gross Tots! FIN. SWE Other' 308-96-2619 444045745 Male I40T Tue Sc!e TOG Fri Sot Sun Hours Rate Fringe Fringe This Job Gross FICA SDI/90I Pusicts Not 9 - 1 leg 8.00 8.00 8.00 0.00 32.00 29.19 933.71 933.36 132.72 41.09 50.19 637.03 933.71 31.93 NICHOLAS S. SQOILLACE 2216 E. TBOMP907I 3D_ INDIAIAPOL IS, IN 46227 09-06 09-03 09-08 09-09 09-10 09-1! 09-12 Total Cash Arty Gross Total FR.: SWH Other 307-02-1123 Caucasian Hale Mon Tue Thu Fri Sat Sun Hours Rate Fringe Fringe This Job Gross FICA S0I/S0I Deducts Ne_ S - 2 Reg 8.00 3.00 20.20 161.00 191.30 83.53 25.02 38.03 589.49 111.10 11.03 K ENNETH WRIGHT P.O. BOK 311 INB.PLLI IN 96043 09-0E 09-01 09-08 09-09 09-10 09-11 09-12 Total Cash linty' Gross Total NTH SWH Other 106-56-9813 Caucasian Hale Mon Tue 'Ned Thu Fri Sat Sun Hours Rate Fringe Fringe This Job Gross FICA SCI!SBI Deducts Ne_ Y - 0 leg 3.00 8.00 8.00 0.00 32.00 21.49 686.08 686.08 88.35 21.13 121.32 395.60 181.00 52.40 ro`e!s !o_ CAR/EL PLC 09-01-'-0 09-07-10 09-08-10 09-09-10 09-10-10 09-I1-10 09-12-10 Total Gross Total Konhay Tuesday ned esdy Thursday Friday Saturday' Sunday Hours This 6306 Gross UPC11CtiOn3 NeL .00 117.00 112.00 104.00 91.00 .00 .00 .29.00 10201.00 12,599.28 nu 905_98 9,3555_59 Plot 969.00 948 109.62 ills 0u Other 933.65