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HomeMy Public PortalAbout2020-12-08 packetNotice of Meeting and Tentative Agenda City of Jefferson, Missouri BOARD OF PLUMBING EXAMINERS AND REVIEW Tuesday, December 8, 2020 — 5:00 p.m. Missouri River Conference Room 102 — Webex Meeting JOHN G. CHRISTY MUNICIPAL BUILDING - 320 E. MCCARTY STREET MEETING NUMBER (ACCESS CODE): 146 903 3519 MEETING PASSWORD: 1234 JOIN BY PHONE +14043971516 US TOLL GLOBAL CALL-IN NUMBERS I TOLL-FREE CALLING RESTRICTIONS JOIN FROM A VIDEO SYSTEM OR APPLICATION DIAL 1469033519(O7JEFFERSONCITY.WEBEX.COM YOU CAN ALSO DIAL 173.243.2.68 AND ENTER YOUR MEETING NUMBER. JOIN USING MICROSOFT LYNC OR MICROSOFT SKYPE FOR BUSINESS DIAL 1469033519.JEFFERSONCITY(a)LYNC.WEBEX.COM TENTATIVE AGENDA 1. Roll Call 2. Approval of Minutes for the February 19, 2020 Meeting. 3. Approval of Minutes for the October 27, 2020 Meeting. 4. Review applicants requesting a Journeyman or Master's License with the City of Jefferson. 5. Old Business a. Plumbing License Renewals 6. New Business 7. Adjournment Individuals should contact the ADA Coordinator at (573) 634-6570 to request accommodations or alternative formats as required under the Americans with Disabilities Act. Please allow three business days to process the request. MINUTES CITY OF JEFFERSON BOARD OF PLUMBING EXAMINERS & REVIEW February 19, 2020 MEMBERS PRESENT: Brent Haas Mike Lage Jerry Raithel Brent Streeter MEMBER ABSENT: Gary Michel COUNCIL LIAISON ABSENT: Ron Fitzwater STAFF PRESENT: Richard Hunt, Plumbing Inspector Larry Burkhardt, Building Official CALL TO ORDER The Board of Plumbing Examiners & Review met February 19, 2020, in the Thomas Jefferson Room of the John G. Christy Municipal Building. The meeting was called to order by Richard Hunt, Plumbing Inspector, at 5:00 p.m. A quorum was present. APPROVAL OF MINUTES FROM THE SEPTEMBER 10, 2019 MEETING A motion was made by Mike Lage and seconded by Jerry Raithel to approve the minutes of the September 10, 2019 meeting. Motion passed by show of hands. APPROVAL OF MINUTES FROM THE FEBRUARY 11, 2020 MEETING A motion was made by Brent Streeter and seconded by Brent Haas to approve the minutes of the February 11, 2020 meeting. Motion passed by show of hands. REVIEW LICENSE APPLICATIONS • A motion was made by Brent Haas and seconded by Brent Streeter to approve Steve Harting to receive his Master's license. Motion was tabled by a show of hands, until Steve can provide proof that he has passed the National Standard Master Plumbing with Gas Exam, with a 75% or higher score. • A motion was made by Jerry Raithel and seconded by Brent Haas to approve Nathan Haller to receive his Master's license. Motion passed by a show of hands. • A motion was made by Mike Lage and seconded by Brent Streeter to approve Caleb Luebbering to receive his Journeyman's license. Motion passed by a show of hands. • A motion was made by Brent Haas and seconded by Jerry Raithel to approve Craig Bruemmer to receive his Journeyman's license. Motion passed by a show of hands. 1 OLD BUSINESS • Larry Burkhardt, City Building Oficial, presented a draft for the Water Conditioning License Guidelines. A motion was made by Jerry Raithel and seconded by Brent Streeter, to approve the draft. Motion passed by a show of hands. NEW BUSINESS • Larry Burkhardt informed Board Members the necessary process to review and adopt the 2018 IPC Code. • The Board was notified that Don Bernskoetter Plumbing is currently operating without a Licensed Master Plumber. Therefore, Don was given a written deadline of April 1, 2020, by which to employ a full-time Master Plumber, in order to comply with City licensing requirements, and obtain a Plumbing Contractor License. • Mike Lage inquired as to whether City Administration would consider implementing a cell phone application, through which users could submit permit applications and inspection request. Larry Burkhardt stated that the City Budget currently lacks ample funding to support that suggestion. SCHEDULE NEXT MEETING The Plumbing Examiners & Review Board's next meeting date is tentatively Tuesday, March 24, 2020 at 5:00 p.m., in the Thomas Jefferson Room of the John G. Christy Municipal Building. ADJOURNMENT With no further business, a motion was made by Mike Lage and seconded by Brent Haas to adjourn the meeting. Motion passed by show of hands. The meeting was adjourned at 6:20 p.m. Respectfully submitted, Richard Hunt 2 MINUTES CITY OF JEFFERSON BOARD OF PLUMBING EXAMINERS & REVIEW October 27, 2020 MEMBERS PRESENT: Brent Haas Jerry Raithel MEMBERS ABSENT: Mike Lage Gary Michel Brent Streeter COUNCIL LIAISON PRESENT: Ron Fitzwater STAFF PRESENT: Richard Hunt, Plumbing Inspector GUEST PRESENT: Jeremy Wilhelm, Journeyman Plumber at Harold G. Butzer CALL TO ORDER The Board of Plumbing Examiners & Review met October 27, 2020, in the Thomas Jefferson Room of the John G. Christy Municipal Building. The meeting was called to order by Richard Hunt, Plumbing Inspector, at 5:00 p.m. A quorum was not present. Therefore, the meeting adjourned at 5:30 p.m. SCHEDULE NEXT MEETING The Plumbing Examiners & Review Board's next meeting date is tentatively Tuesday, November 17, 2020 at 5:00 p.m., in the Thomas Jefferson Room of the John G. Christy Municipal Building. Respectfully submitted, Richard Hunt 1 CITY OF JEFFERSON Dept of Planning & Protective Ser./ices, Building RegUlatior-is Division 320 E. Mc:+�arty St., Jefferson Coity, MO 65101 - 573-634-6451 PLUMBING CONTRACTOR LICENSE APPLICATION 2020 APPLICATION MUST BE COMPLETED AND SUBMITTED WITH LICENSE FEE. OF $210.00 AT THE TIME OF ISSUE OR RENEWAL. Ih:FORMATION ON THS APPLICATION SHALL BE CURRENT, A, -CURATE, AND LEG 4L. CHANGES MUST BE REPORTED TO THE CITY OF JEFFERSON, WITHih: THII:TY (30) CALENDAR DAYS. Piease print or type information. DATE: 6--W?-O BUSIN8.SS NAME: J -t Ww-, i}vti\b L(� -- --- -- ADDRESS:-- CITYi STATE: Ful Lo•1 /�'� iss c� "� __ — ,� 2:1 P: MAILING ADDRESS (if different than above) :__,,.—-- — -- CITY, STATE: _ Y.� _, ZIP: BUSING:SS PHONE: c,—T'2j- _) &'-?3•- 0S? -3 - CELL: ` �.+`ec��l�+� sic,►4�b�.n.� 1 • cap BUSINESS OWNER'S NAME: �C.�o�t'� �''��-kr``� r. EMAIL: i , FAX 4E: (�) MASTER's SS NO (or last 4 digits)__._,_„ MASTER PLUMBER: ?�[r� � � <<� MASTER'S SIGNATURE: MASTER PLUMBER'S BOND #: 63 N) E ONE) EFFECTIVE DATE: -�,r� j�,C��- (. iC' _— BOND RENEWI-'.L DATE: 11 /Z O BONDING COMPANY: L�% '' -� PRIMARY TYPE OF BU%llgE:3S (Check one) L� COMMERCIAL 2RESIDENTIAL ❑ BOTH OFFICE OF THE CITY LICENSE INSPECTOR FLAT EEE BUSINESS 320 EAST MCCARTY ST. LICENSE JEFFERSON CITY, MO 65101 PRONE: (573)634-6322 FAX: (573)634-6329 APPLICAITION EMAIL: biUing@jeffcitmo or9 OUTSIDE CITY LIMITS CHECK ONE OF THE FOLLOWING: NEW BUSINESS:efo"00, CHANGE IN LOCATION: ❑ CHANGE IN OWNERSHIP: ❑ BUSINESS NAME: �c.�a\,A pjuoy(19 t LL Doing Business As: BUSINESS PHYSICAL LOCATION:•7(�./s &Xf,���+ 7OC46 LIZ -6 MAILING ADDRESS (IF DIFFERENT THAN ABOVE): PHONE # 5?3.&?• j -L'5 `?3 � FAX # CELL # EMAIL: M�C1nli��iv;�t�o:�1 -�, wC�-1�� • C01A A TYPE OF BUSINESS/GOODS/ SERVICES TO BE OFFERED (BE SPECIFIC): f V 1✓1 , !!�`l�w �1n5�'�.ti �`c�'t,��.� �,,,�Sz:u:tz} APPROXIMATE # OF EMPLOYEES: OWNER NAME:��� OWNER HOME t•�/./n 7� "1` +y'�% /tom f� I ADDRESS: OWNLR PHONE # ,-7.3-6'-23-Gt.S `'3 MISSOURI STATE TAX ID NUMBER: yCilCcrRr r_V1h=if i1VCC til it nG Rel►\/COC I frcC .,cC tt A3-1Z9G6? �5.fav Vr.. •1-6�I��r ..v 1l-r-ry 11 V1•r/.•..1-IBJ I-IVV •Jr-il 0 DATE YOU WISH TO BEGIN CONDUCTING BUSINESS: INTENDED HOURS OF OPERATION: 6,43C) - S=CtC! c) -K CONTRACTORS: ir—>I NO REQUIRED TO CARRY WORKERS COMPENSATION, PER MISSOURI STATE STATUTE 287.06:17 . YES .__. _., r r err r .r. .r tli yuu eltbwelCu yGb, we will IICCU d l.V}Jy UI yUUI LC111111.Air.. ++ yuu C111JWCICu Ilu; yuu Illuai iiiC e+l +"++'�+utivii. ul cxrill}�i+tnl nn Workers Compensation with our office (attached). ALARM COMPANY NAME AND PHOPlE NUMRFR (IF APPI ICARI F): EMERGENCY AFTER HOUR CONTACT NAME AND PHONE n NUMBER: M�. �✓�- lu.�.l ��\� S <3'-'�r�'���Z I affirm that the information on this application is factual, that this business will be conducted in accordance with all applicable State and City laws and that all City taxes/fees have been paid. I understand that if I am approved that any false statements made by me on this application may result in the revocation of This license. SIGNATURE: DATE: (Owner/Officer/Authorized Agent) Z O Z �� PitlNi NHw:� ;-31= `t�r>ss=fi• tz�cv cs — tyle (-W' {;:; ;-;�;_ �z� ;i> �:• d V,)Vle� individuals should contact the ADA Coordinator at (573) 634-6570 to request accommodations or alternative;ormats as required under the Americans with Disabilities Act. Please allow three business days to process the request. OFFICIAL RESULTS REPORT W27 - National Standard Master Plumber with Gas Name: richard mechlin Candidate ID: ICNON142624 Address: 7615 Cr 428 Date: 9/22/2018 Fulton MO 65251 EXAMINATION RESULT: PASS Congratulationsl You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating Jurisdiction It you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements In each jurisdiction where licensing is desired. It Is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at BBB -422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: •^• PearsonyuE mmrauthenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfelt score reports. Regishation Number. 340325396 Validation Number. 550361381 Or t ;6.* City of Jefferson Department of Planning & Protective Services -Itopt ft 320 E. McCarty Street Jefferson City, MO 65101 Phone: 573-634-6451 nianning0jeffersoncit vino. org �1?V —' www.jefferioncitymo.gov 2020 Plumbing License Application A� Name: F�(�arl� I" V_641yk Date: Address: �t'�15 C `nil Izcct6 4 )�Ad G 1 City State Zip II I PIU t4c Employer: VU ��4K. Phone: S9.3--&'-)3 '0,9 3 SSN (or last 4 digits) ___--=--.,— E-mail: Jy[eLtXkk'A as,� Have yozNo peared before the plumbing Board of Review & Examiners of the City of Jefferson for any cause? ED] Yesif so, please provide date and reason: APPLICATION IS HEREBY MADE FOR THE FGLLO11AIING PLUMBING LICENSE: ❑ Apprentice License, ($12.00 fee Payable to City of Jefferson) Requirements: An applicant for an Apprentice Plumbing License must SUbmit their name, address, and phone number with the twelve dollar ($12.00) fee to the Plumbing Inspector. This license is renewable each calendar year. Holder of an apprentice plumbing license may only work under the direct supervision of a licensed master or journeyman plumber. The ratio of apprentices to journeyman or master is two (2) to one (1). ❑ Journeyman Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for a Journeyman Plumbing License must have been licensed as an apprentice with the City of Jefferson a minimum of four (4) years and shall have worked under the direct supervision of a licensed journeyman or master plumber during these four (4) years or show proof of four (4) years plumbing experience acceptable to the Board by submitting proof of 8000 hrs. working time as a plumber on company letterhead with phone numbers of obtainable individuals supplying the letter. Failure to supply this information will result in Plumbing Board dismissal. Unce hours are approved they must score a minimum of /57o on the Frometric txamination or vearson vut. Master Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for Master Plumbing License shall have been licensed as a journeyman with the City of Jefferson a minimum of two (2) years or provide proof of licensed journeyman or master experience acceptable to the hoard. Applicant will not be considered by the Plumbing Board until 12,000 hrs. proven time in trade as plumber is submitted on company letterhead with phone numbers of obtainable individuals supplying the letter. Once hours are approved applicant must score a minimum of 75% on the Prometric Examination or Pearson NUE. LJ i:L•QUtS'l SPUNSURSHIP FOR THE FOLLOWING EXAM: ($100 fee Payable to Prometric*, or $100 Payable to Pearson VUE**) ❑ Journeyman Plumbing Examination ❑ Master Plumbing Examination *Prometric accepts money orders, cashier's checks, certified checks or credit cards. **Pearson VUE accepts money orders, certified checks, cashier's checks, electronic checks, debit or credit cards. False statements of any kind on this application may invalidate the application or result in the revocation of applicant's certiticate, if issued. hereby verify that all facts resented with this application are true: I e y fy p Signature ALLAC.� PLUMBING INC. 1819 GORDON ST COLUMBIA, MO 65201 PHONE NUMBER (573) 449-4014 FAX NUMBER (5733 875-8018 Richard Mechlin worked for Wallace plumbing from 9/11/2011 to 10/01/2018. Approximately 14,000 hours Blake Berry/Manager - — City of Jefferson Department of Planning & Protective Services 320 E. McCarty Street Jefferson City, MO 65101 Phone: 573-634-6451 icnlanningfteffersoncityrno. orq www.jeffersoncitymo.gov 2020 Plumbing License Application Name: _ 10"rk BerAAC0eA-6r- - Address: Q1 1 1 A4f M 0 &&6-10 1 City n kOF 'StlIatee--P44mb rp Employer. S 4Ta" SIG Date: Ih I aaa B 0 P I --a r2.'✓'r-k-1 P"1 Phone: 5r3^ 5q�5 45 1 a SSN (or last 4 digits) E-mail: bern5koc 1019 �) It 0E . W M Have you ever appeared before the Plumbing Board of Review & Examiners of the City of Jefferson for any cause? ❑ Yes K No if so, please provide date and reason: APPLICATION IS HEREBY MADE FOR THE FOLLOWING PLUMBING LICENSE: ❑ Apprentice License, ($12.00 fee Payable to City of Jefferson) Requirements: An applicant for an Apprentice Plumbing License must submit their name, address, and phone number with the twelve dollar ($12.00) fee to the Plumbing Inspector. This license is renewable each calendar year. Holder of an apprentice plumbing license may only work under the direct supervision of a licensed master or journeyman plumber. The ratio of apprentices to journeyman or master is two (2) to one (1). ❑ Journeyman Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for a Journeyman Plumbing License must have been licensed as an apprentice with the City of Jefferson a minimum of four (4) years and shall have worked under the direct supervision of a licensed journeyman or master plumber during these four (4) years or show proof of four (4) years plumbing experience acceptable to the Board by submitting proof of 8000 hrs. working time as a plumber on company letterhead with phone numbers of obtainable individuals supplying the letter. Failure to supply this information will result in Plumbing Board dismissal. Once hours are approved they must score a minimum of 75% on the Prometric Examination or Pearson VUE. Master Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for Master Plumbing License shall have been licensed as a journeyman with the City of Jefferson a minimum of two (2) years or provide proof of licensed journeyman or master experience acceptable to the Board. Applicant will not be considered by the Plumbing Board until 12,000 hrs. proven time in trade as plumber is submitted on company letterhead with phone numbers of obtainable individuals supplying the letter. Once hours are approved applicant must score a minimum of 75% on the Prometric Examination or Pearson VUE. ❑ REQUEST SPONSORSHIP FOR THE FOLLOWING EXAM: ($100 fee Payable to Prometric*, or $100 Payable to Pearson VUE**) ❑ Journeyman Plumbing Examination ❑ Master Plumbing Examination *Prometric accepts money orders, cashier's checks, certified checks or credit cards. "Pearson VUE accepts money orders, certified checks, cashier's checks, electronic checks, debit or credit cards. False statements of any kind on this application may invalidate the application or result in the revocation of applicant's certificate, if issued. I hereby verify that all facts presented with this application are true: vel GAG Signature CITY OF JEFFERSON Dept of Planning & Protective Services, Building Regulations Division 320 E. McCarty St., Jefferson City, MO 65101 - 573-634-6451 PLUMBING CONTRACTOR LICENSE APPLICATION 2020 APPLICATION MUST BE COMPLETED AND SUBMITTED WITH LICENSE FEE OF $210.00 AT THE TIME OF ISSUE OR RENEWAL. INFORMATION ON THIS APPLICATION SHALL BE CURRENT, ACCURATE, AND LEGAL. CHANGES MUST BE REPORTED TO THE CITY OF JEFFERSON, WITHIN THIRTY (30) CALENDAR DAYS. Please print or type information. BUSINESSNAME:IJOn ?.W05VO'C�Vr- P1 u'MV)�n-1, Ue ADDRESS: _I 'JOGIz R CITY/STATE: i L MAILING ADDRESS (if different than above) CITY/STATE: W DATE: � �I�120ZC� ZIP: ZIP: BUSINESS PHONE: 6) �q-I5-43io CELL:5-13} to c1 L1 -2-j BUSINESS OWNER'S NAMED l��r�� ✓'1'1Sttue �"�' EMAIL: bewc'k.OelftnQIM b 0 GGO -c,)0--7 FAX #: () MASTER's SSN# (or last 4 digits) MASTER PLUMBER: 6t(K MASTER'S SIGNATURE:17& MASTER PLUMBER'S BOND #. 6- �BOND EFFECTIVE DATE: RnniniMr r'nnnpativ• (l 7p5kM Sc fi (" 4-y �.0 BOND RENEWAL DATE. one PRIMARY TYPE OF BUSINESS (Check) EICOMMERCIAL F1RESIDENTIAL BOTH INVOICE DON BERNSKOETTER PLUMBING, INC. 9711 BODE FERRY RD JEFFERSON CITY, MO 65101 573-694-2188 January 16, 2020 Richard Hunt City of Jefferson rhunt ieffcitymo.org RE: D. Mark Bernskoetter-Master Plumber's License SSN-. D. Mark Bernskoetter was employed by Don Bernskoetter Plumbing, Inc. as a journeyman plumber from 1996 thru 101712020. He has accumulated the following hours during his time at Don Bernskoetter Plumbing, Inc.: 1996 to present: 43,680 Please contact me if you need additional information. Sincerely, Tonya Bernskoetter Don Bernskkoetter Plumbing, Inc. INTERNATIONAL CODE COUNCIL Name: Address: OFFICIAL RESULTS REPORT F27 - National Standard Master Plumber with Gas Donald Bernskoetter 9711 BODE FERRY RD JEFFERSON CITY MO 65101 Candidate ID: Date: EXAMINATION RESULT: PASS ICNON158401 10/7/2020 Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authent/otion found at: www.PeamonVVE.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 382443006 Validation Number. 1001571770 BERNDON-01 LMILU CERTIFICATE OF LIABILITY INSURANCE DAT 7/15!2/1612II2YY1fl 020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the poiicy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements) PRODUCER ! C �r�jr''�[�;CT Leslie Mills Fortress Insurance Services PHONE - --- _ .__--_-_Fax 1114 E. Ohio St IANC, No. Ed):(660) 885-2266 (AJ, NOL Clinton, MO 64735 ;Lest it@Mefortressinsurance.com _ �y _-----___ .INSURER(§) AFFORDING COIERAOE -- _ _ ...__ NAIC tt_ -- -INSURERA:S@Cora Insurance INSURED INSURER 8: Guard Berkshire Don Bernskoetter Plumbing Inc. INSURER C c 9711 Bode Ferry Road INSURER D: --.—.—.----------- T ----- ~ ._-. _._ — -- .....Y_._.__ •-- -- Jefferson City, MO 65101 _ - - -- -- - - - - - _ _ - _ ._._-.._.__.._... _ _-------.__._._....._. INSURER E: INSURER F: COVERAGES CERTIFICATE NU BER: REVISION NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUWNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ` ILTIR NSR ADDLTYPE OF INSURANCE IN50 WVD SUER POLICY NUMBER POLICY EFF POLICY EXP YA LIMITS A X `COMMERCIAL GENERAL LIABILITY EACH OC' S 1,000,000 CLAWS -MADE X OCCUR)( 80 -TC -003325589 7/112020 7/112021 DA61l4CEi0REiJieG -- _ 250,000 -- ----------- MSD EXFAny one rsoni 10,000 PEN SONO s ADV INJURY S 1,000,000 uEML nGGRE�s:±'E LtMUT APPLIES PER t: -� r GENERkAGGREGATE s 3 000 000 , , X POLICY P��, LOC - ,, �- _ RODUC- _ COMPrOP AcG s - --- - - -3,0,000 00 - -- —- 0TH=R: s A AUTOMOBILE LIABILITY coMtslN9SINGLE LIMIT 1,000.004 X- ANY AUTO G CA3325591 7/1/2020 7/112021 eox y IIJURY rPwp••s�► s OWNED SCHECULEt AQTOS ONLY AUTOS - .9QOiLY Itl}URY jeer 2;.cJent)--3 - - ..._.---_...._._. --__ - •-- H..��p rIt TN v4svrp MJTOS ONLY kUTOS �7!iti PRCiPER'� Df MAGE �PerBcc l!—_.__ ----•.-----= ----.-_-.---- c - --•• _--.__. - _ UMBRELLA LIAB OCCUR EACH OCWRRENCE ' S --_ F,tCESSLIAB -_- -- CL:.IIAS-11AOE AGGRESWE_._-- DED RETENnON S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER O-! H- - X YIN ANY PROPRIETOWPARTNERrX=_CUINE - DOWC165309 711/2020 71112021 Y N /A _ 51w. ER c L E:,CHaCCIOENT S - _ 500,000 RrFFiCER/MEM3°R EXCLUDEC? anrd- ry In FITi) - 600,000 E.L DISV$E_EA EMPLOYEE S--` If yes. da&wbe `order DESCRIPTION OF OPERATIONS below E.I.DISEASE - POLICY LINUT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES, BE CANCELLED BEFORE For Bid Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIDNS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ODJ Western Surety Company CONTINUATION CERTIFICATE Western Surety Company hereby continues in force Bond No. 42808771 briefly described as PLUMBER CITY OF JEFFERSON CITY , as Principal, in the sum of $ FIVE THOUSAND AND NOJ 100 Dollars, for the term beginning Feb uaa 24 2020 , and ending February 24 2021 , subject to all the covenants and conditions of the original bond referred to above. This continuation is issued upon the express condition that the liability of Western Surety Company under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed the total sum above written. Dated this 10th day of January , 2020 THIS "Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND. Form 90•A•8-2012 WESTERN URETY COMPANY 1.. v Paul T. Br at, Vice President Sxt- THIS "Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND. Form 90•A•8-2012 OD% Western Surety Company CONTINUATION CERTIFICATE Western Surety Company hereby continues in force Bond No. 42808771 briefly described as PLUMBER CITY OF- JEMRSON CITY for DON BERN KOEI:CER PLUMBING, -INC , as Principal, in the sum of $ FIVE THOLISANDDollars, for the term beginning February 24 , 2020 , and ending February 24 2021 , subject to all the covenants and conditions of the original bond referred to above. This continuation is issued upon the express condition that the liability of Western Surety Company under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed the total sum above written. Dated this 10th day of January I _ 2020 . WESTERN URETY COMPANY r By Paul T. Br at, Vice President THIS "Continuation Certificate" MUST BE FILED VMH THE ABOVE BOND. Forth 90-A-8-2012 OFFICIAL RESULTS REPORT 673 - Missouri (Jefferson City) Journeyman Plumber Name: Kyle Gunnels Candidate ID: IC2000139241 Address: 18 Grim Drive Date: 12/29/2016 Kirksville MO 63501 EXAMINATION RESULT: PASS Congratulationsl You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www.PeamonVUE.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 309539913 Validation Number. 83656101 City of Jefferson Department of Planning & Protective Services 320 E. McCarty Street Jefferson City, MO 65101 Phone: 573-634-6451 16ptanning0ofiersonciivmo.ora www.jeffersoncityma.gov 2020 Plumbing License Application Name: \� I G Gt AnL Address: g G6 ►nn D r t tae, I� 6` su" WI, M o (9 13 SO t City ! State Zip Employer: aaota I,,. ct-'Z0. e Date: 0 2 a Phone: SSN (or last 4 digits) E-mail e t A P "0 4 • (,O hn Have you ever appeared before the Plumbing Board of Review & Examiners of the City of Jefferson for any cause? Yes 1:1No If so, please provide date and reason: Sc J. f`,Ga 1A '�� •�AA_ �'r`iO' APPLICATION IS HEREBY MADE .FOR THE FOLLOWING PLUMBING LICENSE: ❑ Apprentice License, ($12.00 fee Payable to City of Jefferson) Requirements: An applicant for an Apprentice Plumbing License must submit their name, address, and phone number with the twelve dollar ($12.00) fee to the Plumbing Inspector. This license is renewable each calendar year. Holder of an apprentice plumbing license may only work under the direct supervision of a licensed master or journeyman plumber. The ratio of apprentices to journeyman or master is two (2) to one (1). Journeyman Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for a Journeyman Plumbing License must have been licensed as an apprentice with the City of Jefferson a minimum of four (4) years and shall have worked under the direct supervision of a licensed journeyman or master plumber during these four (4) years or show proof of four (4) years plumbing experience acceptable to the Board by submitting proof of 8000 hrs. working time as a plumber on company letterhead with phone numbers of obtainable individuals supplying the letter. Failure to supply this information will result in Plumbing Board dismissal. Once hours are approved they must score a minimum of 754 on the Prometric Examination or Pearson VUE. ❑ Master Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for Master Plumbing License shall have been licensed as a journeyman with the City of Jefferson a minimum of two (2) years or provide proof of licensed journeyman or master experience acceptable to the Board. Applicant will not be considered by the Plumbing Board until 12,000 hrs, proven time in trade as plumber is submitted on company letterhead with phone numbers of obtainable individuals supplying the letter. once hours are approved applicant must score a minimum of 75°x6 on the Prometric Examination or Pearson VUE. ❑ REQUEST SPONSORSHIP FOR THE FOLLOWING EXAM: ($100 fee Payable to Prometric*, or $100 Payable to Pearson VUE**) ❑ Journeyman Plumbing Examination ❑ Master Plumbing Examination *Prometric accepts money orders, cashier's checks, certified checks or credit cards. **Pearson VUE accepts money orders, certified checks, cashier's checks, electronic checks, debit or credit cards. False statements of any kind on this application may invalidate the application or result In the revocation of applicant's certificate, if issued. I hereby verify that all facts presented with this application are true: S i g n alt re INDIVIDUAL EMPLOYMENT RECORD COMPLETE WORK HISTORY KYLE R GUNNELS 18 GRIM DRIVE KIRKSVILLE, MO 63501 AS OF 10/01/2020 RUN DATE 10/01/20 (CONTINUATION) Month Worked First -- Last GROSS MEMBER EMPLOYER MONTH HOURS EARNINGS TYPE ASSESSMENTS DUES REG HRS 0/T HRS RATE HAROLD G BUTZER KAMS MECHANICAL INC LLC 06/2019 06/2019 43.00 32.00 $1,831.62 $1,058.24 A2 $.00 $.00 40.00 3.00 41.16 HAROLD G BUTZER INC 06/2019 24.00 $987.84 AB A2 $44.97 $41.98 $27.00 $.00 32.00 24.00 .00 33.07 41.16 HAROLD HAROLD G G BUTZER BUTZER INC INC 07/2019 08/2019 168.00 $7,337.52 D1 $311.84 $27.00 160.00 .00 8.00 42.66 HAROLD G BUTZER INC 08/2019 32.00 123.00 $1,293.12 $5,247.18 D1 D2 $277.96 $.00 $27.00 $.00 32.00 123.00 .00 40.41 HAROLD HAROLD G G BUTZER BUTZER INC INC 09/2019 09/2019 88.00 $3,879.36 D1 $297.01 $27.00 72.00 .00 16.00 42.66 40.41 HAROLD G BUTZER INC 09/2019 63.50 8.00 $2,783.57 $325.60 D2 D2 $.00 $.00 $.00 $.00 60.00 8.00 3.50 42.66 40.70 HAROLD G BUTZER INC 10/2019 34.00 $1,373.94 D1 $338.75 $27.00 34.00 .00 40.41 HAROLD HAROLD G G BUTZER BUTZER INC _ INC 10/2019 10/2019 147.00 $6,271.02 D2 $.00 $.00 147.00 .00 .00 42.66 HAROLD G BUTZER INC 11/2019 8.00 152.00 $325.60 $6,484.32 D2 D1 $.00 $275.58 $.00 $27.00 8.00 152.00 .00 40.70 42.66 HAROLD HAROLD G G BUTZER BUTZER INC INC 12/2019 12/2019 83.00 $3,354.03 D1 $325.66 $27.00 83.00 .00 .00 40.41 HAROLD G BUTZER INC 01/2020 100.00 60.00 $4,308.66 $2,424.60 D2 D1 $.00 $121.18 $.00 $27.00 98.00 60.00 2.00 42.66 40.41 HAROLD HAROLD G G BUTZER BUTZER INC INC 01/2020 01/2020 10.00 16.00 $426.60 $705.60 D2 $.00 $.00 10.00 .00 .00 42.66 HAROLD G BUTZER INC 02/2020 77.00 $3,313.62 A2 D3 $29.99 $.00 $.00 $.00 16.00 67.00 .00 10.00 44.10 40.41 HAROLD G BUTZER INC 02/2020 11.00 $447.70 D3 $.00 $.00 11.00 40.70 HAROLD G BUTZER INC 02/2020 48.00 $2,047.68 D3 $.00 $.00 48.00 .00 42.66 HAROLD G BUTZER INC 02/2020 8.00 $350.72 D3 $.00 $.00 8.00 .00 43.84 HAROLD G BUTZER INC 02/2020 16.00 $776.80 D3 $.00 $.00 16.00 .00 48.55 HAROLD G BUTZER INC 03/2020 83.00 $4,364.28 D3 $.00 $.00 56.00 .00 27.00 40.41 HAROLD G BUTZER INC 03/2020 63.50 $2,751.57 D3 $.00 $.00 61.50 2.00 42.66 HAROLD G BUTZER INC 03/2020 56.00 $2,357.60 D3 $.00 $.00 56.00 42.91 HAROLD G BUTZER INC 03/2020 7.00 $460.32 D3 $.00 $.00 .00 .00 7.00 43.84 HAROLD G BUTZER INC 04/2020 137.00 $6,008.18 Al $255.35 $27.00 137.00 40.41 HAROLD G BUTZER INC 04/2020 10.00 $.00 Al $.00 $.00 8.00 .00 2.00 42.91 HAROLD G BUTZER INC 05/2020 116.00 $6,692.58 Al $284.43 $27.00 116.00 40.41 HAROLD G_BUTZER INC 05/2020 34.00 $.00 Al $.00 $.00 8.00 .00 26.00 42.66 HAROLD G BUTZER INC 06/2020 88.00 $7,907.40 Al $336.06 $27.00 88.00 40.41 HAROLD G BUTZER INC 06/2020 102.00 $.00 Al $.00 $.00 102.00 .00 42.66 HAROLD G BUTZER INC 07/2020 150.00 $6,586.50 Al $279.93 $27.00 150.00 .00 .00 43.91 HAROLD G BUTZER INC 07/2020 0.00 $.00 Al $.00 $.00 .00 .00 .00 EMPLOYEE TOTALS 24,644.50 613,865.92 23,159.81 3,227.00 Name: Bryan Hand Candidate ID: ICNON159872 Address: 2751 Old Tuscumbia Rd Date: 10/30/2020 Eldon MO 65026 EXAMINATION RESULT: PASS Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www.PearsonVUE,com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number. 384594246 Validation Number. 20697773 OFFICIAL RESULTS REPORT W28 - National Standard Journeyman INTERNATIONAL CODE COUNCIL Plumber with Gas Name: Bryan Hand Candidate ID: ICNON159872 Address: 2751 Old Tuscumbia Rd Date: 10/30/2020 Eldon MO 65026 EXAMINATION RESULT: PASS Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www.PearsonVUE,com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number. 384594246 Validation Number. 20697773 City of Jefferson Department of Planning & Protective Services 320 E. McCarty Street Jefferson City, MO 65101 Phone: 573-_634-6451 www.jeffersoncitymo.gov 2020 Plumbing License Application Name: �i` (� V1 XV'L Address: UM 1 1 1 40V\ City Employer: GQY—a-T�PLL State Zip Date: 11) `" 3y `2-v �6 Phone: 3- 2 &— 0-D 6 SSN (or last 4 digits) E-mail: Have you ever appeared before the Plumbing Board of Review & Examiners of the City of Jefferson for any cause? ❑ Yes A No If so, please provide date and reason: APPLICATION 1S HEREBY MADE FOR THE FOLLOWING PLUMBING LICENSE: ❑ Apprentice License, ($12.00 fee Payable to City of Jefferson) Requirements: An applicant for an Apprentice Plumbing License must submit their name, address, and phone number with the twelve dollar ($12.00) fee to the Plumbing Inspector. This license is renewable each calendar year. Holder of an apprentice plumbing license may only work under the direct supervision of a licensed master or journeyman plumber. The ratio of apprentices to journeyman or master is two (2) to one (1). Journeyman Plumbing License, ($105 fee Payable to City of Jefferson) ' `Requirements: An applicant for a Journeyman Plumbing License must have been licensed as an apprentice with the City of Jefferson a minimum of four (4) years and shall have worked under the direct supervision of a licensed journeyman or master plumber during these four (4) years or show proof of four (4) years plumbing experience acceptable to the Board by submitting proof of 8000 hrs. working time as a plumber on company letterhead with phone numbers of obtainable individuals supplying the letter. Failure to supply this information will result in Plumbing Board dismissal. Once hours are approved they must score a minimum of 75% on the Prometric Examination or Pearson VUE. ❑ Master Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for Master Plumbing License shall have been licensed as a journeyman with the City of Jefferson a minimum of two (2) years or provide proof of licensed journeyman or master experience acceptable to the Board. Applicant will not be considered by the Plumbing Board until 12,000 hrs. proven time in trade as plumber is submitted on company letterhead with phone numbers of obtainable individuals supplying the letter. Once hours are approved applicant must score a minimum of 75% on the Prometric Examination or Pearson VUE. ❑ REQUEST SPONSORSHIP FOR THE FOLLOWING EXAM: ($100 fee Payable to Prometric*, or $100 Payable to Pearson VUE**) ❑ Journeyman Plumbing Examination ❑ Master Plumbing Examination *Prometric accepts money orders, coshier's checks, certified checks or credit cards. **Pearson VUE accepts money orders, certified checks, cashier's checks, electronic checks, debit or credit cards. False statements of any kind on this application may invalidate the application or result in the revocation of plicant's certificate, if issued. I hereby verify that all facts presented with this application are true: Signature THIS SPACE FOR OFFICIAL USE - The Board has determined that this application be: ❑ Approved ❑ Denied on this date: Congratulations your application for Plumbing License has been approved: ❑ approved without comments. ❑ approved with the following comments, This application has been denied for the following reason: ❑ lack of verifiable documentation showing time employed in the craft of plumbing. ❑ failed to make a passing score on the pluming exam, ❑ Other Remarks:. Individuals should contact the ADA Coordinator at (573) 634-6570 to request accommodations or alternative formats as required under the Americans with Disabilities Act. Please allow three business days to process the request. PR Employee Leave History Detail r Actual Dates: First -Last Leave Code: App Hrs Emp. :11009 06 -:Bryan -Scott ` Hand Hire Date: 08124115 Leave Code Totals Current Date Range Avail Carry Available Leave Code Balance Over Accrued Bal Ad' Taken Balance App Hrs Apprentice Hours 9,539.25 9,539.25 9,539.25 0.00 0.00 9,539.25 Total for Ern ployee : 900106 9,539.25 9,539.25 9,539.25 0.00 0.00 9,539.25 1 QuesTec Constructors Page 17 10/29/20 12:22:11 PM Date Format - MM/DD/YY PREmpLvHistDet.rpt °.::100106'::;:: Brlyan' Scott Hand Continued Leave Actual'.* Post Aini lab e Code Descriptron Mth . ::Trans :Date Date Bal Adj '.' Accrued : • Usage App Hrs: Grp:100 Pds:10/25/20-10/25/2C 10/20 3418 10/19/20 10/27/20 0.00 8.00 0.00 App Hrs Grp:100 Pds:10/25/20-10125/2C 10/20 3419 10/20/20 10/27/20 0.00 8.00 0.00 App Hrs Grp:100 Pds:10/25/20-10/25/2C 10/20 3420 10/21/20 10/27/20 0.00 8.00 0.00 App Hrs; Grp:100 Pds:10/25/20-10/25M 10/20 3421 10/22/20 10/27/20 0.00 8.00 0.00 App Hrs Grp:100 Pds:10125120-10/2512C 10/20 3422 10/23/20 10/27/20 0.00 8.00 0.00 10120 Totals 0.00 191.00 0.00 1 QuesTec Constructors Page 17 10/29/20 12:22:11 PM Date Format - MM/DD/YY PREmpLvHistDet.rpt OFFICIAL RESULTS REPORT F28 - National Standard Journeyman Plumber with Gas Name: Brent Monteer Address: 8 Dogwood Ct ST Elizabeth Candidate ID: Date: MO 65075 EXAMINATION RESULT: PASS ICNON156506 2/25/2020 Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your Participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www.PearsonVQE.Com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 369769533 Validation Number. 1046803127 �C) 5 5 3 (a `7 City of Jefferson Department of Planning & Protective Services 320 E. McCarty Street Jefferson City, MO 65109 Phone: 573-634-6459 icplanningajefferson citymo. orq www.jeffersoncitymo.gov 2019 Plumbing License Application Name: v\+ /t1 Address: (Au1; Mf X City State Zip Employer: FTOC� zy z Date: Z Z �� Phone: � i3— 11 —ZLo q Soc. Sec. # E-mail:�.1r Have you ever appeared before the Plumbing Board of Review & Examiners of the City of Jefferson for any cause? ❑ Yes E9 o If so, please provide date and reason: APPLICATION IS HEREBY MADE FOR THE FOLLOWING PLUMBING LICENSE: ❑ Apprentice License, ($12.00 fee Payable to City of Jefferson) Requirements: An applicant for an Apprentice Plumbing License must submit their name, address, and phone number with the twelve dollar ($12.00) fee to the Plumbing Inspector. This license is renewable each calendar year. Holder of an apprentice plumbing license may only work under the direct supervision of a licensed master or journeyman plumber. The ratio of apprentices to journeyman or master is two (2) to one (1). /. Journeyman Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for a Journeyman Plumbing License must have been licensed as an apprentice with the City of Jefferson a minimum of four (4) years and shall have worked under the direct supervision of a licensed journeyman or master plumber during these four (4) years or show proof of four (4) years plumbing experience acceptable to the Board by submitting proof of 8000 hrs. working time as a plumber on company letterhead with phone numbers of obtainable individuals supplying the letter. Failure to supply this information will result in Plumbing Board dismissal. Once hours are approved they must score a minimum of 75% on the Prometric Examination or Pearson VUE. ❑ Master Plumbing License, ($105 fee Payable to City of Jefferson) Requirements: An applicant for Master Plumbing License shall have been licensed as a journeyman with the City of Jefferson a minimum of two (2) years or provide proof of licensed journeyman or master experience acceptable to the Board. Applicant will not be considered by the Plumbing Board until 12,000 hrs. proven time in trade as plumber is submitted on company letterhead with phone numbers of obtainable individuals supplying the letter. Once hours are approved applicant must score a minimum of 75% on the Prometric Examination or Pearson VUE. ❑ REQUEST SPONSORSHIP FOR THE FOLLOWING EXAM: ($100 fee Payable to Prometric*, or $100 Payable to Pearson VUE**) ❑ Journeyman Plumbing Examination ❑ Master Plumbing Examination *Prometric accepts money orders, cashier's checks, certified checks or credit cards. **Pearson VUE accepts money orders, certified checks, cashier's checks, electronic checks, debit or credit cards. False statements of any kind on this application may invalidate the application or result in the revocation of applicant's certificate, if issued. I hereby verify that all facts presented with this application are true: Signature r -. a, .o d ►p rt - C m p 00 _ G c o :z`� R' C n CC �_0 o- N N'CIO, Z Q o f O `=7 W C" T'17 t0 cin til h ,D ►21 "M CrQ CD � r 0 ro Cz 5 �Qcoy , acr co -. pn r cn r H .co CD 4 CD C, 5. C, CD C VJ CC03 C. Q• Al O 3G Date: 01/08/2020 Time: 7:57:55AM QuesTec Mechanical EMPLOYEE PAYROLL HISTORY SUMMARY For period from beginning to end ------------------Hours------------------ -----------------------Taxes-------------------------- Pay Period Regular Sick Gross Wage Fed State Issue Date Overtime Holiday Fed Tax Gross Soc Sec Local Check Type Premium Vacation Non -tax Adjust Medicare Disability Check # Net Pay Employee Brent Monteer Number 408 12/17/2017 12/20/2017 Regular 12354 12/24/2017 12/27/2017 Regular 12472 12/31/2017 01/03/2018 Regular 12555 Employee 408 Total Page: 21 ------------Deductions & Benefits ------------- Union Ded Union Bft W/C & GIL Ded W/C & GIL Bft Comp/Misc Ded Comp Bft 401 k I S125 Ded 401k / S125 Bft Social Securit; 40.00 0.00 1,306.40 214.73 59.00 0.00 270.00 0.00 0.00 1,308.83 81.15 0.00 0.00 31.99 0.00 0.00 0.00 18.98 0.00 0.00 90.88 932.54 0.00 0.00 32.00 0.00 1,045.12 149.41 43.00 0.00 216.00 0.00 0.00 1,047.55 64.95 0.00 0.00 25.59 0.00 0.00 0.00 15.19 0.00 0.00 90.88 772.57 0.00 0.00 24.00 0.00 918.56 117.77 35.00 0.00 108.00 0.00 16.00 920.99 57.10 0.00 0.00 22.50 0.00 0.00 0.00 13.35 0.00 0.00 90.88 695.34 0.00 0.00 4,447.00 0.00 106,190.53 14,012.10 4,030.00 0.00 20,417.67 14.00 120.00 106,278.01 6,589.24 0.00 0.00 2,659.33 0.00 88.00 0.00 1,541.03 0.00 0.00 9,513.91 80,018.16 0.00 0.00 Grand Total Recap Earnings Code Hours PR Time Card Entry List 1 Regular 3,494.50 All PRGroups All Payroll Dates All Employees Cert Jobs Only? N 2,255.40 All Post Dates Totals by Posting Date? Y Earnings ReCap? Y All Timecards All Work Orders Pay Timecard Seq Date State Loc Craft PRDepU Craft/Class Temp Sit JCDept Ins GUJCIEM Eq Cost Equipment Equipment Rev Cert Cds Job/Phase CT Equipment Code Usage Phase Code EC Rate Hours Amt Grand Total Recap Earnings Code Hours Amt 1 Regular 3,494.50 99,178.95 2 Overtime 74.50 2,255.40 6 Holiday 152.00 2,972.00 10 Training 133.00 2,012.00 15 PTO - Hourly 164.00 3,276.00 16 Unpaid Time Off 117.00 0.00 18 LTD Taxable 0.00 250.05 23 Weather -Related Day Off 99.50 0.00 24 Training - Unpaid 64.00 0.00 28 STD Taxable 0.00 136.79 1 Employee(s) Grand Totals 4,298.50 110,081.19 1 DuesTec Mechanical Page 108 01/0820 07:41:59AM Date Formal - MM/DD/YY PRTimeCardEntryLS.rpt