Fillable Printable Payroll Certification for Public Works Projects - New Jersey
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
6.
GROSS
AMOUNT
EARNED
7.
DEDUCTIONS
1.
NAME AND ADDRESS
OF EMPLOYEE
2.
WORK
CLASSIFICATION
Overtime (OT) or
Straight time (ST)
HOURS WORKED EACH DAY
4.
TOTAL
HOURS
5.
RATE
OF PAY
This
Project
Only
Total for
Week
FICA
With-
holding
Tax
Total
Deduc-
tions
8.
NET
WAGES
PAID FOR
WEEK
9.
Total
Fringe
Benefit
Cost/Hr.
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
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
I,
(Name of signatory party) (Title)
do hereby state and certify:
(1) That I pay or supervise the payment of the persons employed by
on the ;
(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.
