CA A-1-131 2008-2025 free printable template

CERTIFICATION must be completed see back Form A-1-131 Rev 01/08 Please note that this form has been resized from 8. DIR CALIFORNIA DEPT. OF INDUSTRIAL RELATIONS PUBLIC WORKS PAYROLL REPORTING FORM PAGE CONTRACTOR/SUBCONTRACTOR NAME ADDRE CONTRACTORS LICENSE OF PROJECT NAME AND ADDRESS OR LOCATION DESCRIPTIO SPECIALTY LICENSE STRAIGHT TIME OVERTIME WORK CLASSIFICATION WITHHOLDING EXEMPTIONS EMPLOYEE S NAME ADDRESS AND SOCIAL SECURITY WORKERS COMPENSATION POLICY S/T GROSS AMOUNT EARNED ON PROJECT...S DEDUCTIONS CONTRIBUTIONS AND PAYMENTS CHECK NUMBER DAY DATE HOURS WORKED EACH DAY ALL O/T THIS S/T Straight Time O/T Overtime SDI State Disability STATE TAXES SDI VACATION HOLIDAY HEALTH WELFARE PENSION TRAINING DUES TRAVEL SUBS SAVINGS MEDICARE OTHER TOTAL DEDUCTS NET PAID FOR WEEK FEDERAL FICA SOC SEC FUND ADMIN. PROJECT CONTRACT HOURLY RATE OF PAY FOR WEEK ENDING SELF-INSURED CERTIFICATE TOTAL HOURS WORKED PAYROLL OTHER Any other deductions contributions and/or payments whether or not...required by prevailing wage determinations must be separately listed. Use extra sheets if necessary. 5 x 14 to 8. 5 x 11. Get all of your construction related forms at http //www. TheContractorsGroup*com I the undersigned am the Print Name Position in Business. with the authority to act for and on behalf of Name of Business/Contractor I certify under the penalty of perjury that the records or copies thereof submitted dated to and consisting of Insert Description of Documents and Number of Pages...are the originals or true full and correct copies of the originals which depict the payroll record s of the actual disbursements by way of cash check or whatever form to the individual or individuals named* This employer has complied with the requirements of Sections 1771 1811 and 1815 for all work performed on this public works project. All apprentices if any employed in the period covered by this document are duly registered in a bona fide apprenticeship program registered with the State of...California s Division of Apprenticeship Standards. I hereby certify that the full and complete Prevailing Wages were paid as currently published and posted by the Director of Industrial Relations State of California and only deductions as authorized under the laws of the State of California or the laws of the United States of America have been made from these sums. All other deductions are clearly listed for each employee on an attachment as required by the Director of Industrial Relations State...of California* benefit s of the plan s listed* 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 payroll payment of fringe benefits as listed in the contract have or will be made to the appropriate programs for the benefit of such employees except as noted below. Each laborer or mechanic listed in the above payroll has been paid as indicated on this payroll an amount not less than the...sum of the applicable basic hourly rate plus the amount of the required fringe benefits as listed in the determination for the craft except as noted below.