Fillable Printable Payroll Certification for Public Works Projects - New Jersey

Payroll Certification for Public Works Projects - New Jersey

PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS

(for Contractor and Subcontractor’s Use for Weekly and Final Certification)

(N.J.A.C. 12:60-2.1 and 6.1)

NAME OF CONTRACTOR OR SUBCONTRACTOR ADDRESS DATE WAGES DUE DATE WAGES P AI D

PAYROLL NO.

WEEK ENDING OR FINAL CERTIFICATION

/ /

PROJECT NAME AND LOCATION

CONTRACTOR REGISTRATION NUMBER

3. DAY AND DATE

GROSS

AMOUNT

EARNED

DEDUCTIONS

NAME AND ADDRESS

OF EMPLOYEE

WORK

CLASSIFICATION

Overtime (OT) or

Straight time (ST)

HOURS WORKED EACH DAY

TOTAL

HOURS

RATE

OF PAY

This

Project

Only

Total for

Week

FICA

With-

holding

Tax

Total

Deduc-

tions

NET

WAGES

PAID FOR

WEEK

Total

Fringe

Benefit

Cost/Hr.

Questions? Please contact the Division of Wage and Hour Compliance at (609) 292-2259 or (609) 292-2283.

R-08-12-08

SUBMIT TO PUBLIC BODY OR LESSOR

Date

(Name of signatory party) (Title)

do hereby state and certify:

(1)That I pay or supervise the payment of the persons employed by

onthe;

(Contractor or Subcontractor) (Project Name and Location)

that during the payroll period beginning on , and ending on , all persons employed

(Date) (Date)

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

(Contract or or Subcont ractor)

from the full 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 the New Jersey

Prevailing Wage Act, N.J.S.A. 34:11-56.25 et seq. and Regulation N.J.A.C. 12:60 et seq. and the Payment of

Wages Law, N.J.S.A. 34:11-4.1 et seq.

(2) That any payrolls otherwise under this contract required to be submitted 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 incorpor ated 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 with the United States Department

of Labor, Bureau of Apprenticeship and Training and enrolled in a certified apprenticeship program.

(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 mechanic listed in the above

referenced payroll, payments of fringe benefits as listed in the contract have been or will be

made when due to ap propriate programs for the benefit of such employees, except as noted in

Section 4(c) bel ow.

(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 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)FRINGE BENEFITS

EXCEPTIONS (CRAFT)

REMARKS

PLEASE SPECIFY THE TYPE OF BENEFIT PROVIDED AND NOTE THE TOTAL COST

PER HOUR IN BLOCK 9 ON THE REVERSE SIDE*

1) Medical or hospital coverage



2) Dental coverage



3) Pension or Reti rement



4) Vacation, Holidays



5) Sick days



6) Life Insurance



7) Other (Explain)



* TO CALCULATE THE COST PER HOUR, DIVIDE 2,000 HOURS INTO THE BENEFIT

COST PER YEAR PER EMPLOYEE.

(5) N.J.S.A. 12:60-2.1 and 6.1 – The Public Works employers shall submit to the public body or lessor a

certified payroll record each pay period within 10 days of the payment of wages.

NAME AND TITLE

SIGNATURE

THE FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE

CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMIN AL PR OSECU TI ON. N.J.S .A. 34 :11 -

56.25 ET SEQ. AND N. J.A.C. 12:60 ET SEQ. AND N.J.S.A. 34:11-4.1 ET SEQ.