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CERTIFIED PAYROLL REPORT

CERTIFIED PAYROLL REPORT . Employer Name & Address Name of General / Prime Contractor Project Name & Location Contracting Public Authority Points North (CPW Sample Reports) Points North (CPW Sample Reports) Stable Work 2904. Columbus, OH. 371 Canal Park Dr Columbus, OH 43085. Check if subcontractor Week Ending PAYROLL # Project Number 11/28/2010 1 1 1. Page_____Of_____ 2904. 2. 4. 5. 6. 7. Fringes: 8. Total 9. Total 10. 11. 12. 1. Employee Name, Address Work 3. Hours Worked - Day & Date Project Base Project Cash Hours Gross Taxes Other NET. and Social Security Number Class Total Hrs. Rate Gross Approved Plans All Jobs All Jobs Withheld Deducts Paid Cash & Approved Plans Mon Tue Wed Thu Fri Sat Sun H&W Pens Vac App Other 11/22 11/23 11/24 11/25 11/26 11/27 11/28.

CERTIFIED PAYROLL REPORT Employer Name & Address Check if subcontractor Name of General / Prime Contractor Project Name & …

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