Employee Daily Project Report - Excel - Excel by fmi50884

VIEWS: 0 PAGES: 12

More Info
									Please visit the following link for detailed instructions of how to complete the SDDOT's Certified Payroll Report:
                                   http://www.sddot.com/labor_cp.asp

   The U.S. Department of Labor's Final Rule, effective January 19, 2009, stipulates that employees
  full social security numbers and home addresses shall not be included on weekly payroll reports.
Any Certified Payroll Reports for work performed AFTER January 19, 2009, should report employee's
      full name and Individual Identifying Number (e.g. last four digits of social security number).


Notes:
      1. To navigate from cell to cell, please use your "Tab" key (you may need to use
         your arrow keys to enter the daily overtime hours).
      2. Please include the Project Control Number (PCN) and Project Number on your
         Statement of Compliance and Certified Payroll forms.
      3. This is a 10-page form so if you need to print a copy, remember to select
         only the number of pages that you completed.
If you have any questions, please feel free to call 605-773-3795.
f how to complete the SDDOT's Certified Payroll Report:




FTER January 19, 2009, should report employee's




e use your "Tab" key (you may need to use

 Number (PCN) and Project Number on your
                                                                                              Certified Payroll Report
                                                                                              (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)

        PCN NO. (see Note 1):                         PROJECT NO.                                                               WEEK ENDING:                                            COUNTY:


    REPORTING CONTRACTOR                                                                                                         TELEPHONE:                                             CONTRACT LETTING DATE(2)


    PRIME CONTRACTOR:                                                                                                                                                                 WAGE DECISION DATE:

     (See "Instructions" Tab)       Fed    Group                                   T H I S P R O J E C T                                                 A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &         No    Code and     HOURS WORKED EACH DATE (see Note 3)                    Tot. Hrs                 Gross         Total     Total                                                                        NET
   Individual Identifying Number    Tax    Work       Sun.    Mon.    Tue.    Wed.    Thu.    Fri,    Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC     FED Tax          Other   TOTAL       WAGES
(e.g. last 4 digits of SS number)   Exm   Class (4)   03-22   03-23   03-24   03-25   3-26-   03-27   03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld    Withheld     Withheld    Withheld     PAID

                                                       R       E       G               H       R       S         0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                       O       T               H       R       S                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00         0.00
                                                                                                                 0       0.00          0.00

1) Failure to list Project Control Number (PCN) will delay processing.                                                            2) Contract LETTING Date determines the correct Wage Decision Number.
3) Update daily dates and enter daily regular & overtime project hours worked by employees.                                       4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                   Rev: Feb 2009
This SDDOT form is available online at:                       http://www.sddot.com/labor.asp


                                                                                                                           Page 3
                                                                                              Certified Payroll Report
                                                                                              (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)

        PCN NO. (see Note 1):             0           PROJECT NO.             0                                                 WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                  0                                                                                      TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                0                                                                WAGE DECISION DATE:                     1/0/1900

     (See "Instructions" Tab)       Fed       Group                               T H I S P R O J E C T                                                  A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &         No    Code and     HOURS WORKED EACH DATE (see Note 3)                    Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number    Tax       Work    Sun.    Mon.    Tue.    Wed.    Thu.    Fri,    Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)   Exm   Class (4)   03-22   03-23   03-24   03-25   3-26-   03-27   03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

                                                                                                                 0                     0.00
                                                                                                                                                                                                                               0.00          0.00
                                                                                                                 0       0.00          0.00

1) Failure to list Project Control Number (PCN) will delay processing.                                                            2) Contract LETTING Date determines the correct Wage Decision Number.
3) Update daily dates and enter daily regular & overtime project hours worked by employees.                                       4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                   Rev: Feb 2009
This SDDOT form is available online at:                       http://www.sddot.com/labor.asp


                                                                                                                           Page 4
                                                                                                   Certified Payroll Report
                                                                                                   (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):              0           PROJECT NO.               0                                                   WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                  0                                                                                           TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                     0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)       Fed       Group                                      T H I S P R O J E C T                                                A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &         No    Code and      HOURS WORKED EACH DATE (see Note 3)                        Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number    Tax       Work     Sun.    Mon.      Tue.    Wed.      Thu.    Fri,    Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)   Exm    Class (4)   03-22   03-23     03-24   03-25     3-26-   03-27   03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                        R       E         G                 H       R       S         0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                        O       T                    H      R       S                 0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

1) Failure to list Project Control Number (PCN) will delay processing.                                                                 2) Contract LETTING Date determines the correct Wage Decision Number.
3) Update daily dates and enter daily regular & overtime project hours worked by employees.                                            4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                        Rev: Feb 2009
This SDDOT form is available online at:                        http://www.sddot.com/labor.asp

                                                                                                                                Page 5
                                                                                                   Certified Payroll Report
                                                                                                   (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):              0           PROJECT NO.               0                                                   WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                  0                                                                                           TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                     0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)       Fed       Group                                      T H I S P R O J E C T                                                A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &         No    Code and      HOURS WORKED EACH DATE (see Note 3)                        Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number    Tax       Work     Sun.    Mon.      Tue.    Wed.      Thu.    Fri,    Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)   Exm    Class (4)   03-22   03-23     03-24   03-25     3-26-   03-27   03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                        R       E         G                 H       R       S         0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                        O       T                    H      R       S                 0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

                                                                                                                      0                     0.00
                                                                                                                                                                                                                                    0.00          0.00
                                                                                                                      0       0.00          0.00

1) Failure to list Project Control Number (PCN) will delay processing.                                                                 2) Contract LETTING Date determines the correct Wage Decision Number.
3) Update daily dates and enter daily regular & overtime project hours worked by employees.                                            4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                        Rev: Feb 2009
This SDDOT form is available online at:                        http://www.sddot.com/labor.asp

                                                                                                                                Page 6
                                                                                                      Certified Payroll Report
                                                                                                      (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                      T H I S P R O J E C T                                                 A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.      Thu.    Fri,     Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25     3-26-   03-27    03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                             R       E       G                 H       R        S         0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                             O       T                  H      R       S                  0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                    Page 7
                                                                                                    Certified Payroll Report
                                                                                                    (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                  T H I S P R O J E C T                                                     A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.    Thu.    Fri,       Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25   3-26-   03-27      03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                    Page 8
                                                                                                      Certified Payroll Report
                                                                                                      (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                      T H I S P R O J E C T                                                 A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.      Thu.    Fri,     Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25     3-26-   03-27    03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                             R       E       G                 H       R        S         0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                             O       T                  H      R       S                  0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                    Page 9
                                                                                                    Certified Payroll Report
                                                                                                    (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                  T H I S P R O J E C T                                                     A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.    Thu.    Fri,       Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25   3-26-   03-27      03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                   Page 10
                                                                                                      Certified Payroll Report
                                                                                                      (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                      T H I S P R O J E C T                                                 A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.      Thu.    Fri,     Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25     3-26-   03-27    03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                             R       E       G                 H       R        S         0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                             O       T                  H      R       S                  0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                   Page 11
                                                                                                    Certified Payroll Report
                                                                                                    (MEETS STATE AND FEDERAL PAYROLL REQUIREMENTS)


        PCN NO. (see Note 1):                 0            PROJECT NO.              0                                                    WEEK ENDING:                 1/0/1900                   COUNTY:     0

    REPORTING CONTRACTOR                     0                                                                                            TELEPHONE:                       0                     CONTRACT LETTING DATE(2)                      1/0/1900

    PRIME CONTRACTOR:                                                                                                         0                                                                WAGE DECISION DATE:                     1/0/1900


     (See "Instructions" Tab)          Fed       Group                                  T H I S P R O J E C T                                                     A L L          P R O J E C T S (information should match employee pay stubs)
     Employee's Full Name &            No     Code and        HOURS WORKED EACH DATE (see Note 3)                      Tot. Hrs                 Gross         Total     Total                                                                         NET
   Individual Identifying Number       Tax       Work       Sun.    Mon.    Tue.    Wed.    Thu.    Fri,       Sat.     REG       Base          REG           Hours    Weekly        Gross        SOC SEC        FED Tax       Other   TOTAL         WAGES
(e.g. last 4 digits of SS number)     Exm      Class (4)    03-22   03-23   03-24   03-25   3-26-   03-27      03-28    O-T       Wage           O-T         Worked     Fringe      Earnings      Withheld       Withheld   Withheld   Withheld      PAID

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

                                                                                                                          0                     0.00
                                                                                                                                                                                                                                        0.00          0.00
                                                                                                                          0       0.00          0.00

1) Failure to list PCN (formerly PCEMS) will delay processing.                                                                             2) Contract LETTING Date determines the correct Wage Decision Number.
3) Full mailing address required on first report of employee at this project. General Delivery unacceptable.                               4) SDDOT Group Code AND specific Work Classification are required to be reported.
                                                                                                                                                                                                                                            Rev: Sept 2008
This SDDOT form is available online at:                             http://www.sddot.com/labor.asp

                                                                                                                                   Page 12

								
To top