- Weekly Payroll - New York
- Weekly Payroll Certification for Public Works Projects - Pennsylvania
- Payroll Certification - New Jersey
- Labor Certified Transcript of Payroll - Illinois
- Public Works Payroll Reporting Form - California
- Certified Payroll Report - Washington Department of Labor and Industries
Fillable Printable Certified Payroll Report Form - Ohio
Fillable Printable Certified Payroll Report Form - Ohio
Certified Payroll Report Form - Ohio
CERTIFIED PAYROLL REPORT
CONTRACTING PUBLIC AUTHORITYPROJECT NAME AND LOCATIONNAME OF GENERAL/PRIME CONTRACTOREmployer Name and Address
Project NumberPage of Payroll #Week EndingCheck if Subcontractor
1211109. Total8. Total7. Fringes654321. Employee Name, Address,
Net OtherTaxesGrossHoursCash Approved Plans ProjectBaseProjectHours WorkedWork SS#
PaidDeductsWithheldAll JobsAll JobsCash & Approved Plans GrossRateTotal Hrs.Day & DateClass
OtherAppVac.Pens.H & W
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
Date My signature on this form signifies that I pay, or supervise the payment of the employees shown above. I am certifying: 1) That during the pay period reported on this form,
all hours worked on this project have been paid at the appropriate prevailing wage rate for the class of work done. 2) That fringe benefits have been paid as indicated above. 3) That no rebates or deductions
have been or will be made,directly or indirectly from the total wages earned, other than permissible deductions as defined in the Ohio Revised Code Chapter 4115. 4) That apprentices are registered with the
U.S. Department of Labor Bureau of Apprenticeship and Training. The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution.
SignatureName and Title
whpw 1509