WEEKLY PAYROLL CERTIFICATION FOR PUBLIC …

← Back to document page

LLC-25 REV 10-03 (Page 1) WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTSContractor or Subcontractor (Please check one) ALL INFORMATION MUST BE COMPLETEDBUREAU OF LABOR LAW COMPLIANCEPREVAILING WAGE DIVISION7TH & FORSTER STREETSHARRISBURG, PA 171201-800-932-0665CONTRACTORSUBCONTRACT ORADDRESSADDRESSPAYROLL NUMBER WEEK ENDING DATEPROJECT AND LOCATIONPROJECT SERIAL # project #EMPLOYEE (%)WORKCLASSIFICATIONDAY AND DATEHOURS WORKED EACH DAYS-TIME0-TIMEBASEHOURLYRATETOTAL FRINGEBENEFITS(C=Cash)(FB=Contributions) *TOTALDEDUCTIONSGROSS PAYFORPREVAILINGRATE JOB(S)CHECK # C:FB: C:FB: C:FB: C:FB: C:FB:*SEE REVERSE SIDEPAGE NUMBER ___________ OF ____________THE NOTARIZATION MUST BE COMPLETED ON FIRST AND LAST SUBMISSIONS ONLY. ALL OTHERINFORMATION MUST BE COMPLETED WEEKLY .*FRINGE BENEFITS EXPLANATION (FB): Bona fide benefits contribution, except those required by Federal or StateLaw (unemployment tax, workers compensation, income taxes, etc.)

LLC-25 REV 10-03 (Page 1) WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Contractor or Subcontractor (Please check one) ALL INFORMATION MUST BE COMPLETED

  Project, Public, Work, Certifications, Weekly, Payroll, Weekly payroll certification for public, Weekly payroll certification for public works projects