PUBLIC WORKS PAYROLL REPORTING FORM

S = STRAIGHT TIME *OTHER Any other deductions, contributions and/or payments whether or not included or required by prevailing CERTIFICATION MUST be completed form A-1-131 (New 2-80) O = OVERTIME wage determinations must be separately listed. Use extra sheet(s) if necessary (See last page) SDI = STATE DISABILITY INSURANCE California Department of Industrial Relations Page _____ of _____ NAME OF contractor : CONT

state of california statement of compliance contractor/subcontractor contract number first day and date of pay period last day and date of pay period

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  Form, Reporting, Public, Work, Payroll, Contractor, Public works payroll reporting form

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