DATE:
( c ) EXCEPTIONS
I,
EXCEPTION (CRAFT) EXPLANATION
on the
END DATE
and ending:
(4)
(a) NAME AND TITLE SIGNATURE
(b)
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL
OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.
WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS
In addition to the basic hourly rates paid to each laborer or mechanic listed in the above referenced
payroll, payments of the fringe benefits as listed in the contract have been or will be made to
appropriate programs for the benefits of such employees, except as noted in Section4(c) at right
WHERE FRINGE BENEFITS ARE PAID IN CASH
CONTRACTOR OR SUBCONTRACTOR
that during the payroll period commencing on:
Each laborer or mechanic listed in the above references payroll has been paid, as indicated on the
payroll, an amount not less than the sum of the applicable basis hourly wage rate plus the amount of
the required fringe benefits as listed in the contract, except as noted in Section 4(c) at right
all persons employed on said project have been paid in full weekly wages earned, that no rebates have been
or will be made either directly or indirectly to or on behalf of said
CONTRACTOR OR SUBCONTRACTOR
from the full w eek ly wag es earned by any per son and tha t no deductions have been made either directly or
indirectly from the full wages earned by any person, other that 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 Stat. 948, 63 Stat. 108,72 Stat. 357; 40 U.S.C. 276c), as described below
That any payroll otherwise under this contract required to be submitted for the above period are correct and
complete; that t he wage rate for laborers or mechanic contained therein are not less than t he applicable wage
rate contained in any wage determination incorporated into the contract; that the classification set forth
therein for each laborer or mechanic conform with the work he performed.
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.
That I pay or supervise the payment of the persons employed by
CERTIFIED WAGE AND HOUR PAYROLL REPORT
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