HomeMy WebLinkAboutResolution - 1765 - Contract - Henkels & Mccoy Inc - Outside Plant Communications System - 07_26_1984Resolution #17611
Agenda Item #41'I
07/26/84
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RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a Contract for
Outside Plant Communications System Construction between the City of
Lubbock and Henkels and McCoy, Inc., attached herewith, which shall be
spread upon the minutes of the Council and as spread upon the minutes of
this Council shall constitute and be a part of this Resolution as if fully
copied herein in detail.
Passed by the City Council this 26th dQ., -f
ATTEST:
e doyd, City Secretary
APPROVED AS TO ENT:
ill P yne, Director of Administrative Services
APPROVED AS TO FORM:
-� 19 4'zs�a
Do andiver, Assistant City Attorney
JUIV 100/1
CONTRACT
r
STATE OF TEXAS
COUNTY OF LUBBOCK
This agreement, made and entered into this a2l� �`" day of �� ,
1984, by and between the City of Lubbock, County of Lubbock, St to of
actin b and through Alan Henry,Mayor, thereunto authorized to do
Texas. g Y g rY� Y
80s hereinafter referred to as OWNER, and
E the City of 1ue &11, County of n1cn49-?„.jnd State of 9A , hereinafter
armed CONTRACTOR. U—
Witnesseth: That for and in consideration of the payments and
"pgreements hereinafter mentioned, to be made and performed by the OWNER and
'kaijitruction
nder the conditions expressed in the bond bearing even date herewith if
ny) the CONTRACTOR hereby agrees with OWNER to commence and complete the
of certain improvements described as follows:
.&Cc underground duct system and telephone cables from City of Lubbock
micipal Building (10th Street and Texas Avenue) to existing Manhole #34.
Ite underground cables through existing duct system and all necessary
r:x
Inholes from existing Manhole #34 to existing Manhole #234A. Place
IdOrground duct system and cables from existing Manhole #234A to City Hall
'Dth Street and Paris Avenue. All construction mentioned above shown on
Ictap enclosed.
@,'all extra work in connection therewith, under the terms as stated in
3�.Contract documents and at his (or their) own proper cost and expense to oiob all materials, supplies, machinery, equipment, tools, superintendence,
ri!insurance and other accessories and services necessary to complete
laid construction in accordance with the contract documents as defined
411
;General Condition of Agreement.
i7CONTRACTOR hereby agrees to commence work within ten days after
• written notice to do so shall have been given to him and to
tially complete same within the time specified in the contract
t0. -
�vwarK agrees to pay the Contractor in current funds for the
ICe of the contract in accordance with the proposal submitted
'subject to additions and deductions., as provided in the contract
band to make payment on account thereof as provided therein.
Ev1
uavc cxecureu rnis
contract in six (6) counterparts, each of which shall be deemed an
original, in the year and day first above mentioned.
' CITY OF LUBBOCK TEXAS
-- Z-
Mayor
4
City S cretary
�ioPROVED AS TO CONTENT:
;D AS TO .FORM:
CONTRACTOR HENKELS & MCCOT, INC
BY:
4(
TITLE: VICE FREZIDE.111;
COMPLETE ADDRESS:
HENKELS & MCCOY,'NC
BLUE BELL, PA 19422
1
CHANGE ORDER NUMBER 0003 Bid #8017
TO: Mr. Bob Batchelor
Executone of Texas (NW), Inc.
1961 Texas Avenue
Lubbock, Texas 79405
Original Amount of Contract
Net Amount Previous Change Orders
Net Amount the Change Order
Amended Amount of Contract
Percentage Change of Contract Price
Additional Time of Completion
The Date of Substantial Complete
as of this Change Order Therefore
68,356.00
1,172.74
5,000.00
7 ,528. _
�%
-0-
is Novemberl6, 1984
WHEREAS, it is desirable to make changes in the plans and specifications
for this project.
THIS AGREEMENT WITNESSETH: In consideration of the mutual advantage
gained, the Owner and Contractor agree to the change shown herein and in the
attached exhibits and data, the Owner and the Contractor agree that the
original contract between them shall be modified to the extent herein
Indicated.
To correct an oversight in Bid document.
Contractor failed to bid lamp status indicators required for
system to function as designed.
Bid response provided busy lamp fields that provides a
visual indication only if a busy (off hook) condition
exists.
Lamp status indicators that provide visual indications of
incoming calls and a busy condition, and that also provide
an audible indication of incoming calls are required for the
system to function properly.
IN WITNESS WHEREOF, the Owner and the Contractor have hereto set their
hands this the 1st day of November , 1984.
EXECUTONE OF TEXAS, (NW), INC.
BY: C�
TITLE:e mQ
HICKS& RAGLAND GINEERING CO., INC.
CITY OF L B C
OWNER
BY:
Wi 11 ktm J. Payne, ctor
of Administrative Services
APPR D AS 0 CONTENT:
d `Gti
ou rot ro, Communications Supery sor
I
4
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK. TEXAS 79452 / (806) 747-0010
November 6, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-02
Project Designation 89-001-4003-840512
Bid #8018
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Ms. Prothro:
The enclosed invoice, #01-321003, has been prepared by
Henkels & McCoy, Inc. for the project mentioned above. This office
believes the invoice to be an accurate account of the work performed and
recommends final payment be made in accordance with the contract documents.
The labor performed and the materials installed on the project site
are as follows:
17,345.00 (Final 14.1% completed work)
Plus 10,629.37 10% retainage from invoice 01-289656
27,974.37 Final payment due
95,664.34 Partial payment - paid
123,638.71 Total amended amount of contract
Should you have any questions, please don't hesitate to call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY
Steve Carson, Supervisor
Outside Plant
Communications Engineering Division
CSC/h j r
encl.
file
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747-0010
November 6, 1984
RE: Texas 855 - City of Lubbock
Project 89-0001-40003-840512
Bid #8018
J
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Ms. Prothro:
In reviewing the contract between the City of Lubbock and
Henkels & McCoy, there are several documents needed to close out this
project. Listed below are documents that have been sent to your office:
1. Affidavits of Bills Paid; Article 6, Page 4 - Document: "Contractor's
Final Affidavit and Agreement" sent 11/5/84.
2. Guarantees; Article 8, Page 4 - Document: "Letter dated 9/21/84
from Henkels & McCoy" sent 9/25/84.
3. Payment of Employee and Filing of Payment; Article 18, Page 7 -
Documents: "Payroll Filings and Letter dated 9/21/84."
4. Protection Against Claims of Subcontractors, Laborers, Materialmen,
and Furnishers of Machinery, Equipment and Supplies; Article 29,
Page 29 - Document: "Contractor's Final Affidavit and Agreement"
sent 11/5/84.
5. Payments; Article 40, Pages 32-33 - Document: "Contractor's Final
Affidavit and Agreement" sent 11/5/84.
6. Final Completion and Acceptance; Article 42, Page 33 - Document:
"Certificate of completion and Letter dated 10/14/84" sent 10/14/84.
7. Final Payment; Article 43, Pages 33-34 - Document: "Invoice Number
01-321003" sent 11/6/84.
8. Payment Withheld; Article 46, Page 34 - Document to clear known
damage: "Release and Settlement of Claim" sent 11/5/84 and "Letter of
Acceptance from Southwestern Bell" sent 10/30/84.
Ms. Lou Prothro
City of Lubbock
November 6, 1984
Page 2
RE: Texas 855 - City of Lubbock
Project 89-0001-40003-840512
Bid #8018
Enclosed with this letter we are sending you the test results for the
400 pair cable, the coaxial cable, maps, and drawings for construction and
manholes.
Should you need additional documents or not have any of the above,
please notify us.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY JL (�Z� I
Steve Carson, Supervisor
Outside Plant
Communications Engineering Division
CSC/hjr
encl.
file
CITY OF LUBBOCK
PROJECT #89-0001-40003-840512
CERTIFICATE OF COMPLETION
This is to certify all work has been completed in accordance
with the contract documents including the cleanup items.
HICKS & RAGLAND ENGINEERING CO., INC.
BY
Steve Carson, Outside Plant Supervisor
Communications Engineering Division
�4
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747-0010
November 5, 1984
RE: Texas 855 - City of Lubbock
Project #89-001-4003-840512
Bid #8018
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Ms. Prothro:
Enclosed is a "Release and Settlement of Claim" signed by Page & Wirtz
Construction Company releasing Henkels & McCoy and their employee Billy
Phillips for the damage incurred during construction of the underground
telephone cables.
Also, enclosed is the "Contractor's Final Affidavit and Agreement" to
indemnify, defend and hold the "City of Lubbock, Texas" harmless against
the enforcement of any lien, claim or lawsuit, including expenses, attorney
fees and court costs incurred.
Should there be any other claims that we are not aware of, please
contact us prior to final payment.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY ' et4��
Steve Carson, Supervisor
Outside Plant
Communications Engineering Division
CSC/hjr
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, j RELEASE AND SETTLEMENT OF CLAIM
V.
For the sole consideration of
Five Thousand Eight Hundred Seventy Three and 73/100---t-�-
dollars ($ 5873.73
the undersigned hereby releases and forever discharges Henkels & McCoy$ Inc., 7312 S. I-35 j
Austin! Tx, and their employee Billy Phillips
and all other persons, firms and corporations from all claims and demands, rights and causes of action of any kind the under-
signed now has or hereafter -may have on account of or in any way growing out of Personal Injuries known or unknown to
Mat the present time and Property'. Damage resulting or to result from an occurrence which happened on or about
8-23-84 19_, and do hereby- covenant-t indemnify and save harmless the said party or parties
from and against all claims and demands whatsoever on account of or in any way growing out of said occurrence or its results
both to person and property. This release expresses a full and complete SETTLEMENT of a liability claimed and denied,
regardless of the adequacy of the above consideration, and the acceptance of this release shall not operate as an admission of
liability on the part of anyone nor as an estoppel,' waiver or bar with respect to any claim the party or parties released may
have against the undersigned. Witness 'my hand and seal.
(1) Dated 10--17�$4 YOU ARE MAKING A FINAL SETTLEMENT
19
THIS IS A RELEASE: READ BEFORE SIGNING.
(4 )
(Witneu' Signature)
a a 79S�o�
Addressl
(5) `
(Witneu' Signature)
Asa 250 R3 "In" (Address)
USA
(2)
wE HAVE READ THIS RELEASEI
(3) Page & Wirts Construction CoJL.S.)
(Signature)
(3) By �• (LS.)
(Signature)
s
1
-
State of
CONTRACTOR'S FTNAL AFFIDAVIT AND AGRF.FMFNT - SHEET 1
Texas
County of Lubbock
On this 24th
day of
SS.
October
, 19 84 , bef ore me
personally appeared ,.Affiant, who being duly sworn
on his oath did state that:
1. Affiant is the (duly authorized agent of the) contractor who performed
work for the City of Lubbock, Texas owner or occupant
of real estate, easements and rights of way located in the following counties of
the State of Texas
which work included construction or repair work under a contract dated
July 26,_1984 and pursuant- to estimate no. 89-0001-40003-840512
and/or routine order no. which are incorporated herein by
reference.
2. All work required by the said contract and estimate and/or routine
order has been fully and properly performed in accordance with the plans and
specifications contained in the contract, estimate and/or routine order, and
the contractor is entitled to final payment therefor.
3. All persons, -subcontractors materialmen,..equipment suppliers,
mechanics, and workmen who furnished services, equipment, materials and labor
used in the performance of the work, or who assert any claim for such, have'
been paid in full except for the following, from whom lien waivers have been
obtained and are attached hereto:
4. All equipment, fixtures, appliances, furnishings and materials incor-
porated in the work are free and clear of all liens, encumbrances and ownership
claims of whatsoever nature and kind, including chattel mortgages and condition-
al bills of sale, except for the following, from whom lien waivers have been
obtained and are attached hereto:
CONTRACTOR'S FINAL AFFIDAVIT AND AGREEMENT — SHEET 2
5. No claims have been made, or lawsuits filed, by any person for
property damage, personal injury or death arising out of or in any way
connected with the work performed, which have not been paid in full or
finally settled, and Affiant knows of no facts which make likely the
filing of any such claims or lawsuits, except for the following:
6. In consideration of the final payment being made, the waiver of
The City of Lubbock, Texas of any right to withhold payment
or effect a set off payment, and other good and valuable consideration,
Affiant agrees to indemnify, defend and hold The City of Lubbock. Texas
harmless against the enforcement of any lien,
claim, or lawsuit, including expenses, attorney fees and court costs incurred
therefor, arising out of the -performance of the work except for those items
noted in paragraphs 3,4 and'5,above.
Henkels & McCoy, Inc.
Barr Sacks CONTRACTOR
Southwest Division Manager
�;-jij iSed and sworn to before me the day and year above written.
NOTARY PUBLIC
My..Commis-,ion Expires:
aim&*/ _
HIM 13
ROM-
+• ' + * ♦ T ; a_
Henkels and McCoy
P.O. Box 7610--
Philadelphia, PA 19.101
762-6411
P. 0. Box 2000
LUBBOCK, TEXAS 79457
November 5, 1984
CERTIFICATE OF ACCEPTANCE
This is to certify that the City of Lubbock, pursuant to the Certificate
of Completion provided on Project #89-0001-40003-840512, accepts the work
performed on said project -and will make final -payment --for said Project within
31 days hereafter.
CITY OF LUBBOC
s Representative
T
lid
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (606) 747-0010
October 30, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-02
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Ms. Prothro:
Per your request, we are sending you a copy of the letter from
('00,111 Southwestern Bell accepting construction work within their manholes.
Should this not be sufficient, please do not hesitate to call us.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY 4z��
Steve Carson, Supervisor
Outside Plant
Communications Engineering Division
CSC/hjr
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O
Soudimstem Bell
Earl C. Darnell
2010 Avenue R. Room 437
P.O. Box 291
Lubbock, Texas
October 26, 1984
Hicks & Ragland
Steve Carson
P. 0. Box 3008
Lubbock, Texas 79452
Dear Mr. Carson:
Final inspection of Southwestern Bell Manholes has been completed and
no noticeable damage was revealed.
We accept the work as performed in Southwestern Bell's Manholes.
Refer any questions to Bennie C. Smith at 741-5200.
Sincerely,
Earl Darnell
Manager-Engineering(Design)
OCT2 91984
r.--
CUSTOMER STATEMENT
rCUTHWEST PAGE 01
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6ALLAS� TEXAS
AENKEL5VMTOY gnc.
fil m
JOLLY ROAD BLUE BELL PENNSYLVANIA, 19422
PHONE 215-283-7600 TWX 510-661-3963
ACCOUNT NUMBER I DATE
FITY OF LUBBOCK 1ZU16 5 10/19/84
r
r^ ATTN BILL PAYNE
916 TEXAS AVE
LUBBOCK CK TX 79401
10,
L
LISTED BELOW IS THE RECORD OF OUR BILLING TO YOUR ACCOUNT. RECENT PAYMENTS
AND/OR CREDITS NOT APPEARING HEREON WILL BE APPLIED TO THE NEXT STATEMENTS
INVOICE NUMBER
INVOICE DATE
'YOUR P.O. NUMBER
AMOUNT
CUR.
30
gel
RETAINAGE
GE
10,
9/26/84
27,974.37
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CURRENT BILLINGS
OVER 30 DAYPAST
DUE BILLINGS
OVEfl O'DAYS
OVER'90
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GAYS
RETAINAGE
27t974.37
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TOTAL'BILLINGS INCLUDING RETAINAGE --►
27,474.37
�4
61 HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747-0010
October 15, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-02
89-0001-40003-840512
Mr. Benny Smith
Southwestern Bell Telephone
2010 Avenue R
Lubbock, Texas 79411
Dear Mr. Smith:
Per our conversation of October 2, 1984, final inspection of South-
western Bell Telephone manholes were to be made. As of this date, I have
not received any correspondence.from your office stating they have or have
not been inspected.
We are in the process of closing out this project and would appreciate
a letter accepting the work performed in the Southwestern Bell manholes.
Should you have any questions, please do not hesitate to call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
A i
BY
Steve Carson, Supervisor Outside Plant
Communications Engineering Division
CSC/hj r
f ile
cc: Ms. Lou Prothro ��
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747-0010
October 14, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-02
Project # 89-0001-40003-840512
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2008
Lubbock, Texas 79408
Dear Ms. Prothro:
Attached is a list of materials used on the above referenced
project, City of Lubbock's Outside Plant Communication System,
between 916 Texas Avenue and the New City Building located at
13th Street and Paris Avenue, Lubbock, Texas.
The value of all work performed and materials furnished
under this agreement is One Hundred Twenty -Three Thousand, Six
Hundred Thirty -Eight Dollars and Seventy -One Cents ($123,638.71).
A partial payment has been made in the amount of $95,664.34,
leaving a balance of $27,974.37 including retainage. All work
has been completed on this contract and final billing will be
sent by Henkels & McCoy.
Should you have any questions, please do not hesitate to
call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY zq
Gary Ha nhill, Project Coordinator
Communications Engineering Division
CSC/drs
encl.
file
T
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747.0010
October 14, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-02
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2008
Lubbock, Texas 79408
Dear Ms. Prothro:
Enclosed is a "Certificate of Completion" on Project
#89-001-4003-840512 per Article 42, page 33, of the contract
between the City of Lubbock and Henkels & McCoy. A copy of this
certificate will be forwarded to Henkels & McCoy per contract.
The "Certificate of Acceptance" from your office, should be
forwarded to Henkels & McCoy and Hicks & Ragland Engineering
Company.
Should you have any questions, please do not hesitate to
call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY
Gary Havz6fibill, Project Coordinator
Communications Engineering Division
CSC/drs
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file
T
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK. TEXAS 79452 / (806) 747-0010
September 25, 1984
RE: Texas 855 - City of Lubbock
Mr. Stacy Jenkins
Area Manager
Henkels & McCoy, Inc.
7312 South I-35, Suite 142
Austin, Texas 78745
Dear Mr. Jenkins:
On September 24, 1984, the final inspection for the City of
Lubbock, project number 89-0001-40003-840512, took place.
Generally speaking, construction looked good.
The following area items that require your attention for
cleanup.
1. Bonding from tip splice at old City Hall building.
2. Bonding from tip splice at new City Hall building.
3. Dirt work along trench in front of new City Hall building.
The final inspection was made prior to testing of the coax
cable. This test will be completed as soon as possible and when
results are known you will be notified.
Attending the final inspection were Ms. Lou Prothro, City of
Lubbock, Stacy Jenkins, Henkels & McCoy, and Steve Carson,
Hicks & Ragland Engineering Co., Inc.
Yours very truly,
HICKS & RAGLAND ENGINEERING.CO:y..INC:;c
BY
,Steve Carson
Outside Plant Supervisor
Communications Engineering Division
CSC/drs
file
cc: °.Ms.'°Lou'Prothro
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. 0. BOX 3008 / LUBBOCK, TEXAS 79452 / (806) 747-0010
September 25, 1984
RE: Texas 855 - City of Lubbock
P&S #44855-02-03
Ms. Lou Prothro
City of Lubbock
P. 0. Box 2000
Lubbock," Texas 79408
Dear Ms. Prothro:
Enclosed are two (2) letters from Henkels & McCoy. One
letter states their intention to guarantee the material and
workmanship per Article 8, page 4 of the "General Instruction to
Bidders". The other letter states that the work has been completed
or substantially completed and Henkels & McCoy is requesting a
final inspection per Article 42, page 33 of the contract.
Should you have any questions on this matter, please do not
hesitate to call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY
Steve Carson
Outside Plant Supervisor
Communications Engineering Division
CSC/drs
encl.
f ile
cc: Mr. Stacy Jenkins, Henkels & McCoy
14ENKELS EM`COY,� ,'.
September 21, 1984
City of Lubbock
916 Texas Avenue
Lubbock, Texas
Attn: Bill Payne
Dear Bill,
ENGINEERS & CONTRACTORS
7312 SOUTH 1-35, SUITE 142
AUSTIN, TEXAS 78745 512/443-6235
At this time we would like to notify your offices that the work
described in project number 89-0001-40003-840512 has, to the best
of our knowledge, been completed. we would like to request a final
inspection and, upon approval or resolution of any problems discovered,
request permission to bill balance of contract amount.
If we may be of further service to you, pleade don't hesitate to call
on us.
4tEy
s truly,
V. enki Area Manager
SVJ/jg
. PERFORMANCE has built our business
HENKElS&MKOY._� e-._
September 21, 1984
City of Lubbock
916 Texas Avenue
Lubbock, Texas
Attn: Bill Payne
Dear Bill,
FN[:INPPRS A [_nNTRO[_TnRS
HUS I I N, I tAAO 1 01 40 0 1 G/4441-0LJ0
With this letter we would like to inform you of our intention to
kjuarantee the materials and workmanship on your number 89-0001-
40003-840512. This of course will not cover the items in the change
order discussed in my letter to Gene Harwell of Hicks & Ragland
Engineering dated 4uly 12, 1984.
It has been our pleasure serving you on this project. Please keep us
in mind for any future telecommunications need you might encounter in
the future.
Your truly,,)
I
4Stacy V. enki Ps
Area Manager
SVJ/jg
. . . PERFORMANCE has built our business
T
HICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK. TEXAS 79452 / (806) 747-0010
September 21, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-03
Bid #8018
Mr. Bill Payne
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Mr. Payne:
Enclosed are copies of payroll filings for Henkels & McCoy
employees engaged on the City of Lubbock project.
This was received September 21, 1984 from Henkels & McCoy to
fulfill Article 18, page 7 of "General Instructions to Bidders"
as part of the documents required.
call.
Should you have any questions, please do not hesitate to
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
BY
Steve Carson
Outside Plant Supervisor
Communications Engineering Division
CSC/drs
encl.
f ile
cc: Ms. Lou Prothro, City of Lubbock
Mr. Stacy Jenkins, Henkels & McCoy - Austin
AAHICKS & RAGLAND ENGINEERING COMPANY, INC.
P. O. BOX 3008 / LUBBOCK, TEXAS 79452 / ( 806 ) 747-001 O
September 21, 1984
RE: Texas 855 - City of Lubbock
P&S #44-855-02-03
Bid #8018
Mr. Bill Payne
City of Lubbock
P. 0. Box 2000
Lubbock, Texas 79408
Dear Mr. Payne:
Enclosed are copies of payroll filings for Henkels & McCoy
employees engaged on the City of Lubbock project.
This was received September 21, 1984 from Henkels & McCoy to
fulfill Article 18, page 7 of "General Instructions to Bidders"
as part of the documents required.
Should you have any questions, please do not hesitate to
call.
Yours very truly,
HICKS & RAGLAND ENGINEERING CO., INC.
Steve Carson
Outside Plant Supervisor
Communications Engineering Division
CSC/drs
encl.
f ile
cc: ^Ms. Lou Prothro, City of Lubbock
Mr. Stacy Jenkins, Henkels & McCoy - Austin
CUSTOMER S T A T E M E N T
ffOUTHWEST PAGE 01
VALLASI ' TEXAS
,� HEN KEL5 a M"COY gnc.
JOLLY ROAD BLUE BELL PENNSYLVANIA, 19422
OL PHONE 215-283.7600 TWX 510-661-3963
"ACCOUNT NUMBER DATE
FCITY OF LUBBOCK 1280605 9/21/84.
ATTN BILL PAYNE
916 TEXAS AVE
LUBBOCK, TX 79401
LISTED BELOW IS THE RECORD OF OUR BILLING TO YOUR
CREDITS NOT APPEARING HEREON, WILL BE APPLIED
-AND/OR
INVOICE NUMBER
INVOICE DATE
YOUR P.O. NUMBER
AMOUNT
CUR
01-289656
9/07/84
951r664.34
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O
z
w
ell
1
EXT STATEMENTS
11- RETAI AGE
CURRENT BILLINGS
OVER 30 DAYS I
0
PAST BILLINGS
DUE
OVER 60 D AYS
OVER
90 DAY
RETAINAGE
95,664*34
000
.00
000
moo
TOTAL BILLINGS INCLUDING RETAINAGE.
95t664.34
City of Lubbock
Project #890001-40003-840512
Final Inventory of Material
1. Filled 400 pr. 26 ga. Telephone Cable
2. JT4750JBD .750 75 ohm Coaxial Cable
3. 4' X 8' X 6' Type "L" Manhole Complete
4. 4' X 8' X 6' Type "A" Manhole Complete
5. 2 Duct 4" PVC Conduit Encased in Concrete
6. Splice Cases
7. Splice Modules 25 pr.
Total
4072 Ft.
4072 Ft.
2 ea.
1 ea.
1493 Ft. (2986' Duct Ft.)
11 ea.
176 ea.
i
1
• U. S..;- ARTMENT OF LABOR
wA66 AND NOUN AND ►U*LIC
CONTOACTS ONHIONf
(for Canlrodoes Optional Use, Sea Inst►udon, Fort" WH . 347 Intl.)
0,
roe.A .�/rn• f t
SaAEM BYI1ru Ha 44-RIBI
NAME OF CONTRACTOR OR SUBCONTRACTOR
Henke CRd.
ADDRESS -
Blue Bell, PA 19422
PAYROLL NO,
FOR WEEK ENDING
P/2/84
PROTECT AND LOCATION
City of Lubbock
PROT[CT OR CONTRACT NO.
411
NAM[.AODRE6S.AND
SOCIAL SELURITY NUMBER
OF ETAPLCYEE
1201
at
0
aY;
_ CIS
t
(31
nu tt_
C�If Kc
6-: 141 DAY AND DATE
151
TOTAL
NOVR!
161•
RATE
PAY
171
AMOUNT
EARNED
1B1
491
NET
wACti
PAID
►Oq WEEK
N MITJ
or
WITDEDUCTIONS
O
IKA
WIT.(-
HOLOIN6
1'"
S ATE
TAX
OTNEII
TOTIL'
[OUCTIONS
D HOURS WORKED EACH DAY
1034
Billy Phillips
S1
277526
0
5
550.00
36.85
108.5
404.59
s
50
10.00
34457
Robt.•Ainsworth
M1
1277527
0
304.00
20.37
33.64
249.99
S
32
9.5o
34458
Frank
SO
277528
0
280.00
18.76
40.48
2
s
40
7.00
-Sepulveda
308978
Daniel Vas uez
3
ISS
0
s
0
s
0
s
0
s
0
s
I
Date 9/13/84
I, Maryann Saybolt Payroll Manager
4Nalne of signatory party) I*ride I
do hereby state:
4 t ) That 1 pay or supervise the payment of the persons employed by Henkel S b
McCoy, Inc. on the City of Lubbock
I Contractor or subcontractor) ; t huNingorwalk) '7«1
that during the payroq period commencing on the 27th
day of August , 1984, and ending ►he2nd dly oSeptember 19 84
all persons employed an said project have been paid the full weekly wages earned, that no rebates
havr bcen or will be made either directly or Indirectly to or on behalf of said
Henkel s & McCoy, Inc,_ from the full
tContractor or wbeontraetoll
weekly wages earned by any person and that no seductions have been made either directly or
Indirectly from the full wages earned by any person, otner than permissible deductions as defined
In Regulations, Part 3 (29 CFR Subtitle A). Issued by the Secretary of Labor under the Copeland
Act, as amended (48 Stal. 948.63 StaL 108. 72 Stat. 967; 76 Sta1. 357.40 U.S.C. 276c), and des-
cribed below:
FICA
FEDERAL WITHHOLDING TAX
(2) That any payrolls otherwise under this contract required to be submilik 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 exist In a" State, are registered with the Bureau of Apprenticeship and Training, United
States Department of Labor.
44) That:
(a) 11'IIF:RE FRINGE IIVNE,FITS ARE PAID TO APPROVED PLANS. FUNDS,
OR PROGRAMS
In addition to the busie hourly wage r-riles paid to each laboter or mechanic
inted in th, Ibu. a referenced pe npments of fringe Retlrfits as listed
In the contract have been or will be made in appropriate programs for the
benefit of such employees, except as noted In Section 4(e) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
❑ — Each laborer or mechanic listed in the above referenced payroll has beta
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 an listed In the contract, except as noted In Section 4(e) below.
(c) 'EXCEPTIONS
EXCEPTION (CtAFT) EXPLANATION
REMARKS
TAME AND TITLE SIGNATURE
Payroll
laryann Saybol t, Manager y1,,C. .� --
Tiff .v'tFUI FALSIFICATION OF ANY OF THE ADCVE STATEMENTS AY SC91ECt TN( CONTRACTOR
41CONfRACIOR 70 v L CCRIMINAI VAOSECJTION S(•I� S[C •IJt. It01 OTITLE la AND
• 1, OF FIVLE 31 OF Tt.E ;.KITED SFATES CODE.
• U.S.�ArARTM[NTOFLAROR
MADE AND ""a AND PUGLIC
CGNTRACTS a1M11K7Nf
(For Contractor's Optional Use; Soo Instruction, Form WH • 347 Intl.)
r
lb...t Rra••r.1. --
el,gw i.rw Nw ��•RIOf�
NAME OF CONTRACTOR[Xj OR SUBCONTRACTOR ❑
Henkels 5 McCoy, Inc.
AOORESS
Jolly Rd., Blue Bell, PA 19422
PAYROLL NO. 1.
Y
FOR W[[K ENDING 8/26/84
PRO) -ECTANOLOCATION TPOOJECT
Cityof Lubbock
OR CONTRACT NO.
• 111 -
NAME, AOORtSS• AND
SOCIAL SECURITY NUMetR
• OF BARLCYEt
211
at
y[
171
u
.CH K-1," `.-
'; 14) GAY AND DATE
ISI
TOTAL
HOURS
161
PATE
OF'AY
171
GROSS
AMOUNT
EARN[O
161
DEDUCTIONS
HI
NET
WAGES
RAID
FOR WttK
a
O 2
►'
21
2
2
FICA
raIN• .'
NOLDINa
TA11
STATE
TAX
OTNEII
TOTAL-
Otis
O HOURS WORK[ 3 CAC. DAY
•..
Billy Phillips
Sl
270218
15.5
865.00
57.9
21.78
585.26
s
71
10.00
34457
Robt.'Ainsworth
M1
270219
a
15,5
821.75
55.05
68.45
35.72
562.53
S
71
9.50
34458
Frank Sepulveda
SO
270220
D
1
605.5
40.57
•
33.81
431.151,
S
71
7.00
307978
Daniel Vasquez
M3
270221
O
432-50
28.9
49'.25
354.27
S
71
5.00
Lupe Lopez
160
0
0
0
0
1
150.00
IS
30
5.00
a
S
o
s
0
t
S
0
S
Date 9/ 13/84
1, Maryann Saybolt Payroll Manger
1Name or signatory Party) tTow I
do hereby state:
(I I Thal I pay or supervise the payment of the persons employed by Henkel s 8
McCoy, Inc. an the _ r 1 ty nf. 1 Ithhfltlt
I l'onweloror wbeeolrsrtor) I Ruitllna or verb!
that during the payroll period commencing on the 20th
day of AU9USt 19 84and ending the26tNay of — August 19 84
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 sold
Henkel s E McCoy, Inc. from the full
t oatreaar 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 denned
In Regulations, Part 9 (29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland
Act, as amended (48 Slat 948,69 Stat. 108, 72 Slat 967; 76 Slat 957; 40 U.S.C. 276e), and des-
crlbed below:
FICA
FEDERAL WITHHOLDING TAX
STATE TAX
(2) That any payrolls otherwbe under this contract required to be submilted 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
(5) That any apprentices employed In the above period are duly registered in a bons fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of Apprentfeeship' and Training, United Stales Department of Labor, or if no such recognised
agency existsIn a Stater, are registered with the Bureau of Apprenticeship and Training, tInited
States Department of Labor.
(4) That:
(s) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,
OR PROGRA161S
J_ In addition to the basic hourly wage rases paid it, each laborer or mechanic
listed in the above rrfrrenccd psyrnit, 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 iess than the sum of the
applicable basic hourly wage rate plus the amount of the required fringe
benents as listed in the contract, except as noted In Section 4(e) below.
(cj EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
REMARKS
NAME ANO TITLE Payroll
SIGNATURE
Maryann Saybolt, Manager
�
THE WILFUL FALSIFICATION Or ANY Or THr ARCVE STATEMENT S MAY lVII)ECr E CONTRACTOR
ON SUnEONfRACTOR TO CIFIL Gil CRIMINAL PROSICJTION E[ SEC'IOh t(OI Or TITLE la AND
SECTION 231 OF TITLE 31 OF ftiE I.-NITEO STATES COOT
• U. L .:-ARTMENT CP LA90"
WAOC ANO HOUR AND •Y$l1C
CONTRACT$ DIW$1011$
(For Cont►aeloes Optional Use; See InTtnuelion, Form WN . 347 l"21.1 '
e11�$.1 �.... r+. u•ttte»
1141,1EOF CONTRACTOR OR sutoco TRACTOR `-Pienkel s 8 McCoy, Inc.
"of S Rd., Blue Bell, PA 19422
PAYROLL NO. 3
FOR WICK ENDING p/ 1 /p4
O O
PROJ%TAND LOCATION -
City of Lubbock
PROJECT OR CONTRACT NO.
• 111
11AME. ADDRESS. AND
SOCIALft
Or d' CVEHUMO[R
212
€
171
`� � K A
F,; 141 OAT AND DATE
451
TOTAL
HR>!JR$
161
RATE
a PAY
979
OAS
EARNED
too
DEDUCTIONS
f1i
NrN ET
rOR WEE"
F
O
F
►►tA
NOL OnT.4- . •
TAM
Alt
TAX
OT1R$R
L�
D HOURS WORKED EACH DAT
1034 ...
Billy Phillips •'
S1
269567
4.5
535..00
35.84
164.0
395.10
$
49
34457
Robt.'•Ainsworth
M1
269568
0
4
455.00
30.49
'62.6
13-7Z
348.13
S
48
8.75
34458
Frank Sepulveda
SO
269575
D
6
406.00
27.20
V
71.98
306.82
52
7-06d
307978
Daniel Vasquez
M3
269569
D
4
260.00
17.42
19 ft 62
222.96
S
48
5.00
•
o
is-
0
S
0
.
0
S
0
S
vote 2/ 13/84
1. Maryann Saybolt Payroll Manager
lNo le of eteastory pony) 47idel
do hereby state:
(1) That 1 pay or supervise the payment of the persons employed by Henkel s E
McCoy, Inc. on the City of Lubbock
t l'oalnelor or wbcoolreHer) (Ru' dlot or work I
that during the payroll period commencing on the 1 3th
day of August 19.0 and ending thel.9.fhy of u U t ig 84
oil persons employed on sold project have been paid the full weekly wages earned, that no rebates
have been or will be made either directly or Indirectly to or on behalf of said
Henke 1 s b McCoy, Inc. from the full
(Contraclor or su eonlreeterl
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, Put 3 (29 C F R Subtitle A). Issued by the Secretary of Labor under the Copeland
Act, as amended (48 Stat 948.63 Slat 108. 72 Stat 967; 76 Slat 357;40 U.S.C. 276e). and des-
cribed below:
FICA
FEDERAL WITHHOLDING TAX
STATE TAX
(2) Thai any payroll* otherwise under this contract required to be submlHid for the above
period are correct and complete-, that the wage rates for laborers or mechanics contained "therein
are not Ins than the applicable wage rates contained In any wage determination Incorporated Into
the contract; that the classifications set forth therein for each laborer or meehanlc'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 Slate apprenticeship agency recognized by the Bureau
of Apprenticeship and Training, United Stain 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.
(41 That:
(a) WIIVRF: FRINGE HENEFITS ARE PAID TO APPROVED PLANS. FUNDS,
OR PROGRAMS
In addition to the basic hourly wage (ales paid to eueh laborer or wk'chuniC
In the contract have been or will be made to appropriate programs for the
benefit of ouch 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 turn 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(e) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
REMARKS ..
NAME AND TITLE Payrol 1 SIGNATURE '?
itr
Maryann Saybol t, Manager t•.�, a
t
THE W(LFUL FALSIFICAT10% OF ANY Or THr A9CVE STATEMENTS MAf SUBJECT THE CONTRACTOR
OR SUBCONTRACTOR TO CGI♦ Ci. CnIMINA1. RIICSEC�TICN SEC Sir ,SN :(01 OF TITLE Is AND
SECTION 211 Of TITLE 31 Of T..E t.NiTEO STAT(S l UDE
Y. ! :.. ARTMENT OF LASOR
W461 AND HOUII AND ►USLIC
tONT""S oMsloNs
(For Conlroclor's Opliono) Use, Soo Instruction, Form WH. 347 Inst.)
PoemA Pn••+J
lard 1wwl1 Ns. 41.g1992
NAME OF CONTRACTOR OR SUBCONTRACTOR
Nenkels McCoy, Inc.
AOORESS
Jolly Rd. Blue Bell PA 1 422
PAYROLL NO. 2
FOR WEEK ENDING 8�1 2�84
►RO)ECTANDLOCATION
City of Lubbock
PRa[CT OR CONTRACT Na
• 111
AND
NAME ADDREs-,OF
SOCIALew `ITY UMBER
21
d
af!
-131
a(+�Ka-#:_
I41 DAY AND DATE
161
TOTAL
NOUR!
161
RATE
OA/AY
171
GROSS
AMOVNT
GRN[D
161
DEDUCTIONS
1*1
WAGES
PAID
FOR WEEK
M
I T
W
T
[1911U
F
O
AX'A
WITN•
No;OIINO
STATE
TAX
OTHtII
TOTAL,-
��
D HOURS WORKED EACH DAY
1034
Billy Phillips
S1
262318
D
1
4301.00
2..8.81
7.3.17
328.02
1
42
10.00
3 457
Rbbt. Ainsworth
M1
262306
0
1
408.50
27.37
52.43
10.93
317.77
s
42
9,.50.
34458
Frank Se ulueda
S0
262324
D
385.00
25'.80
66.73
292.47`
S
50
7.00
307978
Daniel Vasquez
M3
O
S
307706
Mark Langley
S1
262315
0
105.00
7.04
7.27
90.69
S
21
5.00
307707
Javlen Benlonga
M2
-
262309
0
105.00
7.04
2.45
'
A
95.51
s
21
5.00
0
•
s
0
s
o
s
ME
Daft 9113/84
1, Maryann Saybol t . _ Payroll Manager.
!Name of Ilenetory party) !Tidel
do hereby state:
1 t) That I pay or supervlst the payment of the persons employed by Henkel s E
McCoy, Inc. on the City of Lubbock
(IOnlfatlOe Of Wbe001ratWf r
1 I Building at worTt►� '
that during the payroll period commencing on Iht•6th
say of August , 1984, and ending the 12 t. y of — Aug us tt, 19 84
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
Henke 1 s 6 McCoy, Inc. from the full
Ifontractor 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 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland
Act, as amended (48 Slat. 948.63 Slat. 108. 72 Stal. 967; 76 Stat 357;40 U.S.C. 276e), and des-
cribed below:
FICA
FEDERAL WITHHOLDING TAX
_STATF TAX
(31 That any payrolls otherwise under this contract required to be submiltW 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 classiflcadons 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 Rde
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of Apprenticeship and Training, United Slates Department of Labor, or if no such recognized
agency exists in a Slaty are registered with the Bureau of Apprenticeship and Training, Vniled
Slates Department of Labor.
f 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 iechanic
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 bee 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 Payroll SIGNATURE
Maryann Saybol t, Manager �1'Y�/
THE WILFUL FALSIFICATION CF ANY OF THE ABOVE STATEMENTSVAY SuB1ECt THmCONTRACTOR
OR SUBCONTRACTOR TO CIV L CiI CRIMINAL PROSECUTION SEE SECTION 1(01 OF TITLE la AND
SECTION 231 Or TITLE 31 Of THE :.NiTIO STATES CODE.
•
W. L i:wARTMfNTOF LABOR
W"CAND HOUR AND PU9LIC
CONTRACTS .91014111
(For Confrotter's Optional Use; See InvIrliction, Form WH - 347 Inst.)
NAM[ OF CONTRACTOR OR SUBCONTRACTOR C]
Henkels & McCoy, Inc.
R
"Toily Rd., Blue Bell, PA 19422
PAYROLL NO.
FOR WEEK ENDING
1 8/5/84
PROACCity TANOoL ATION k
FLubboc7
PROJECT OR CONTRACT NO.
• off
ilAlilf, Atib"Ess. AND
SOCL49L SECURITY NUMBER
GOP EMPLCYEE
121111
50
N.
-two
131
Check #
141 DAY AND DATE
0%
TOTAL
mouns
461
RATE
OF PAT
1 171
GROSS
AMOUNT
. EARNED
Is$
DEDUCTIONS
lot
mt?
WAGES
PAID
F044 WEEK
11
W
I T
F
I
30
13 11
1
1
J-3-L-
1 - -1
FICA
WITPI-
HOLDIN4
TAX
STATE
TAX
OTHER
TOTAL
EDUMON$
0 HOURSWOR 3 EACH DAY
1034
Billy Phillips
S11
2-55073
0
1
430.04
28.81
73-1
328.02
S
42
I0.0C
34457
Robt. Ainsworth
M, 1
256135
0
2-7
458.3E
30.71
'63.4C
. ,
t3.9
350-3.5
S
45.5
9.5
34458
Frank Sepulveda
S . 0
255061
0
6.5
371.8f
24.91
63.4!
283-52
S
53
62 !
307978
Daniel Vasquez
M3
0
S1
0
S
0
S
0
S
0
S
0
J-
I
1
Date 9/ 13/84 .
1, Maryann Saybolt Payroll Manager
Worse of signatory Perry) � 4T1dt)
do hereby state:
(I ) That I pay or supervise the payment of the persons employed by Henkel s l;
MCCOV . Inc, at the City of LUbbock
i Contractor or subcoouactar► I Building or work)
I that during the payroll perlod famnteneing on tht
day of Jul. 19 84 and ending the �t . of _ Aug us t ib �){
all persons employed on sold project hove 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 sold
Henkel s & McCoy, Inc, from the full
(ontractor or sabeontracwrl
weekly wages earned by any person and thut 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 CFR Subtitle A), issued ny the Secretary of Labor under the Copeland
Act, as amended 148 Stal. 948.63 Stat. 108, 72 Stst 967; 76 Stat. 357,40 U.S.C. 276c), and des-
cribed below:
FICA
FEDERAL WITHHOLDING TAX
STATE
(2) That any payrolls otherwise under this contract required to be submllvW 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 eontalnet! 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 ApprentR"hip and Training, United States Dtporhnem of Labor, or if no such recognized
agency exists In a Stale, are registered with the Durrou of Apprenticeship and Training, tinned
Stales Department of Labor.
(4) That;
to) WIIERF. FRINGE IMNEFITS ARE PAID TO APPROVED PLANS, FUNDS.
OR PROGRAMS
U_ In addition to the basic hourly wage rates paid to ouch laborer or mechanic
listed in the ubove rrfer. r' :.,, ru11, payments of fringe benrras 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(e) below.
(b) WHERE FRINGE BENEFITS ARE PAID 1\ CASH
❑ — Each laborer or mechanic listed In the above referenced payroll hike been
paid, as Indicated on the payroll, an amount not less than the cum of the
applicable basic hourly wage rate plus the amount of the required fringe
benefits as listed In the eonlraet, except as noted In Section 4(e) belbet.
(c) EXCEPTIONS
EXCEPEO (CkAFT) EXPIANATION
REMARKS
}
,IAME AND TITLE SIGNATURE
Payroll
t;
iaryann Saybol t, Manager
To.( wllrUl FALSIFICATION Or Ar,Y OF THE fBCv[ STATfMEN MAY :V91ECr THE ONTRACTOR
OR SUUCONfRACIOR 10 CIY:L Gh CRIMINAL PROS[CW1ION SE[ SCC'ION 1[01 O TITLE la AND
S(Ct.or1 J31 Or IItL[ 31 Or h.E 6hIf10 UTATES G07E
itmiiiiiiiiiiiiiiliiiiiiiliiliiliiilitieiil�ilitillitsle�sse��eeeesllmealsses
llres!!!!!!!!!!iiii!ititaxsslitiil�6ll�eii!!lil7�!!!!!!ii!lliWs!!
■MEN
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