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Form DC-127 12/29/2011 NEW JERSEY DEPARTMENT OF TRNSPORTATION MONTHLY CERTIFICATION OF CONTRACTOR’S PAYROLLS SEE REVERSE SIDE FOR INSTRUCTIONS PROJECT FEDERAL DP NO: NAME: PROJECT NO: SUBCONTRACTOR CONTRACTOR NUMBER OF DATE OF WAGE RATE LAST INSPECTION NAME OF EMPLOYER PAYROLL DATES OF PAYROLLS VERIFIED BY THIS REPORT SUBMITTED PRIOR TO W/THIS THIS REPORT REPORT I certify that, to the best of my knowledge all employees working on this project during this period have been included on a payroll and all payrolls listed above, have been verified, reviewed and accepted in accordance with contract requirements. _______________________________________________________________ _____________________________ RE (Signature) Date INSTRUCTIONS List the names of each employer for which payrolls were received and reviewed. Check whether the employer is the Contractor or a Subcontractor. Show the week ending date of the payroll which was last verified, if any for each employer. List the week ending dates of each payroll being verified as received and reviewed for the month. Show the number of Wage Rate inspections which have been completed and are being submitted with this report. Note: One Wage Rate Inspection is interpreted to mean the interviewing of one (1) employee.
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