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					U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
                                                               Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                   ADDRESS                                                                               OMB No.: 1215-0149
                                                                                                                                                                                                                             Expires: 03/31/2007
                                                                                                                                                                                                                             Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                          PROJECT AND LOCATION                                             PROJECT OR CONTRACT NO.
                20061226001                                                                    12/23/2006                                                                                                                  1000
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                    (5)       (6)         (7)                                                                                (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON    TUE   WED   THUR   FRI                                                               DEDUCTIONS                                CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19     20    21    22     23                             GROSS                                                                        NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                     TOTAL       RATE      AMOUNT                                                           TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                  HOURS      OF PAY     EARNED      FICA     FED         STATE     LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                               0.00      0.00       $62.17                                                                        D00031
345-46-5765                                                                                                                                                               $26.90   $28.28      $11.23      $0.00    $50.39        $116.80
                                                1                            s                        3.88                      2.33        6.22    10.00       $369.67                                                                       $252.87
Jones, Sally                                               Oil Change
3453 Main St                                    S                           o                                                               0.00      0.00       $67.47                                                                        500080
Atlanta, GA 30068                                                                                                                                                         $23.50   $31.66      $12.12      $0.00    $10.00         $77.28
151-51-5151
                                                0                            s                               1.35 7.08                      8.43      8.00      $307.21                                                                       $229.93
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861
U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
                                                               Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                  ADDRESS                                                                                 OMB No.: 1215-0149
                                                                                                                                                                                                                              Expires: 03/31/2006
                                                                                                                                                                                                                              Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                         PROJECT AND LOCATION                                               PROJECT OR CONTRACT NO.
                 20061226001                                                                   12/23/2006                                                                                                                   1001
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                   (5)       (6)         (7)                                                                                  (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON    TUE   WED   THUR   FRI                                                               DEDUCTIONS                                 CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19     20    21    22     23                            GROSS                                                                          NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                    TOTAL       RATE      AMOUNT                                                             TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                 HOURS      OF PAY     EARNED      FICA      FED         STATE      LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                              0.00      0.00      $110.67                                                                          D00031
345-46-5765                                                                                                                                                              $26.90    $28.28      $11.23       $0.00    $50.39        $116.80
                                                1                            s                               4.40 1.50 5.17              11.07     10.00       $369.67                                                                         $252.87
Talley, George                                             Oil Change
, GA                                            S                           o                                                              0.00      0.00       $94.35                                                                          500081
                                                                                                                                                                         $22.74    $20.31        $8.05      $0.00    $24.11         $75.21
                                                1                            s                        6.97               1.10 3.03       11.10       8.50      $305.29                                                                         $230.08
Smith, Jim                                                 Oil Change
453 Marietta St                                 S                           o                                                              0.00      0.00      $118.59                                                                          500079
Atlanta, GA 30068                                                                                                                                                        $28.38    $31.13      $12.38       $0.00    $17.62         $89.51
234-53-7678
                                                1                            s                                     3.98 8.50             12.48       9.50      $380.95                                                                         $291.44
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861
U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
                                                               Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                     ADDRESS                                                                              OMB No.: 1215-0149
                                                                                                                                                                                                                              Expires: 03/31/2006
                                                                                                                                                                                                                              Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                            PROJECT AND LOCATION                                            PROJECT OR CONTRACT NO.
                 20061226001                                                                   12/23/2006                                                                                                                   1002
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                      (5)       (6)         (7)                                                                               (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON    TUE    WED    THUR   FRI                                                             DEDUCTIONS                                 CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19     20     21     22     23                             GROSS                                                                       NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                       TOTAL       RATE      AMOUNT                                                          TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                    HOURS      OF PAY     EARNED      FICA     FED       STATE      LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                                 0.00      0.00       $70.00                                                                       D00031
345-46-5765                                                                                                                                                                 $26.90   $28.28    $11.23       $0.00    $50.39        $116.80
                                                1                            s                                             7.00               7.00    10.00       $369.67                                                                      $252.87
Talley, George                                             Oil Change
, GA                                            S                           o                                                                 0.00      0.00       $80.75                                                                       500081
                                                                                                                                                                            $22.74   $20.31      $8.05      $0.00    $24.11         $75.21
                                                1                            s                               4.93          4.57               9.50      8.50      $305.29                                                                      $230.08
Jones, Sally                                               Oil Change
3453 Main St                                    S                           o                                                                 0.00      0.00       $97.07                                                                       500080
Atlanta, GA 30068                                                                                                                                                           $23.50   $31.66    $12.12       $0.00    $10.00         $77.28
151-51-5151
                                                0                            s                        4.75                 3.33 4.05        12.13       8.00      $307.21                                                                      $229.93
Smith, Jim                                                 Oil Change
453 Marietta St                                 S                           o                                                     0.07        0.07    14.25       $122.71                                                                       500079
Atlanta, GA 30068                                                                                                                                                           $28.38   $31.13    $12.38       $0.00    $17.62         $89.51
234-53-7678
                                                1                            s                                      3.88          8.93      12.82       9.50      $380.95                                                                      $291.44
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861
U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
                                                               Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                    ADDRESS                                                                               OMB No.: 1215-0149
                                                                                                                                                                                                                              Expires: 03/31/2006
                                                                                                                                                                                                                              Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                           PROJECT AND LOCATION                                             PROJECT OR CONTRACT NO.
                 20061226001                                                                   12/23/2006                                                                                                                   1003
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                     (5)       (6)         (7)                                                                                (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON    TUE   WED    THUR   FRI                                                              DEDUCTIONS                                 CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19     20    21     22     23                             GROSS                                                                        NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                      TOTAL       RATE      AMOUNT                                                           TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                   HOURS      OF PAY     EARNED      FICA     FED        STATE      LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                                0.00      0.00       $29.17                                                                        D00031
345-46-5765                                                                                                                                                                $26.90   $28.28     $11.23       $0.00    $50.39        $116.80
                                                1                            s                                     2.92                      2.92    10.00       $369.67                                                                       $252.87
Talley, George                                             Oil Change
, GA                                            S                           o                                                                0.00      0.00       $68.14                                                                        500081
                                                                                                                                                                           $22.74   $20.31       $8.05      $0.00    $24.11         $75.21
                                                1                            s                                     4.22          3.80        8.02      8.50      $305.29                                                                       $230.08
Jones, Sally                                               Oil Change
3453 Main St                                    S                           o                                                                0.00      0.00       $63.60                                                                        500080
Atlanta, GA 30068                                                                                                                                                          $23.50   $31.66     $12.12       $0.00    $10.00         $77.28
151-51-5151
                                                0                            s                        4.18                3.77               7.95      8.00      $307.21                                                                       $229.93
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861
U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
                                                               Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                    ADDRESS                                                                               OMB No.: 1215-0149
                                                                                                                                                                                                                              Expires: 03/31/2006
                                                                                                                                                                                                                              Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                           PROJECT AND LOCATION                                             PROJECT OR CONTRACT NO.
                 20061226001                                                                   12/23/2006                                                                                                                   1004
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                     (5)       (6)         (7)                                                                                (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON   TUE    WED    THUR   FRI                                                              DEDUCTIONS                                 CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19    20     21     22     23                             GROSS                                                                        NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                      TOTAL       RATE      AMOUNT                                                           TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                   HOURS      OF PAY     EARNED      FICA     FED        STATE      LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                                0.00      0.00       $49.83                                                                        D00031
345-46-5765                                                                                                                                                                $26.90   $28.28     $11.23       $0.00    $50.39        $116.80
                                                1                            s                              3.98                 1.00        4.98    10.00       $369.67                                                                       $252.87
Talley, George                                             Oil Change
, GA                                            S                           o                                                                0.00      0.00       $28.33                                                                        500081
                                                                                                                                                                           $22.74   $20.31       $8.05      $0.00    $24.11         $75.21
                                                1                            s                                     3.33                      3.33      8.50      $305.29                                                                       $230.08
Jones, Sally                                               Oil Change
3453 Main St                                    S                           o                                                                0.00      0.00       $79.07                                                                        500080
Atlanta, GA 30068                                                                                                                                                          $23.50   $31.66     $12.12       $0.00    $10.00         $77.28
151-51-5151
                                                0                            s                              4.87                 5.02        9.88      8.00      $307.21                                                                       $229.93
Smith, Jim                                                 Oil Change
453 Marietta St                                 S                           o                                                                0.00      0.00       $70.62                                                                        500079
Atlanta, GA 30068                                                                                                                                                          $28.38   $31.13     $12.38       $0.00    $17.62         $89.51
234-53-7678
                                                1                            s                        4.07 3.37                              7.43      9.50      $380.95                                                                       $291.44
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861
U.S. Department of Labor                                                                              PAYROLL
Employment Standards
Wage and Hour Division
                                                                         (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
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NAME OF CONTRACTOR                  OR SUBCONTRACTOR                                                                                   ADDRESS                                                                                OMB No.: 1215-0149
                                                                                                                                                                                                                              Expires: 03/31/2006
                                                                                                                                                                                                                              Ex

PAYROLL NO.                                                   FOR WEEK ENDING                                                          PROJECT AND LOCATION                                              PROJECT OR CONTRACT NO.
                 20061226001                                                                   12/23/2006                                                                                                                   1005
                         (1)                    (2)              (3)                                  (4) DAY AND DATE                    (5)       (6)         (7)                                                                                 (9)
                                                                                                                                                                                                      (8)




                                             WITHHOLDING
                                                                                         SAT    SUN   MON    TUE    WED   THUR   FRI                                                              DEDUCTIONS                                 CHECK NO.




                                             EXEMPTIONS




                                                                            OT. OR ST.
             NAME, ADDRESS, AND                                                          17     18    19     20     21    22     23                            GROSS                                                                         NET WAGES




                                             NO. OF
           SOCIAL SECURITY NUMBER                              WORK                                                                     TOTAL       RATE      AMOUNT                                                            TOTAL         PAID FOR
                 OF EMLOYEE                                CLASSIFICATION                        HOURS WORKED EACH DAY                  HOURS      OF PAY     EARNED      FICA     FED         STATE      LOCAL     OTHER     DEDUCTIONS       WEEK
Franklin, Sammy                                            Oil Change
Atlanta, GA 30068                               S                           o                                                               0.00      0.00       $47.83                                                                         D00031
345-46-5765                                                                                                                                                               $26.90   $28.28      $11.23       $0.00    $50.39        $116.80
                                                1                            s                        4.78                                  4.78    10.00       $369.67                                                                        $252.87
Talley, George                                             Oil Change
, GA                                            S                           o                                                               0.00      0.00       $33.72                                                                         500081
                                                                                                                                                                          $22.74   $20.31        $8.05      $0.00    $24.11         $75.21
                                                1                            s                               3.97                           3.97      8.50      $305.29                                                                        $230.08
Smith, Jim                                                 Oil Change
453 Marietta St                                 S                           o                                                               0.00      0.00       $69.03                                                                         500079
Atlanta, GA 30068                                                                                                                                                         $28.38   $31.13      $12.38       $0.00    $17.62         $89.51
234-53-7678
                                                1                            s                        3.18 4.08                             7.27      9.50      $380.95                                                                        $291.44
Date                                                                                                                                   (b) WHERE FRINGE BENEFITS ARE PAID IN CASH

I,                                                                    ,                                                                                  Each laborer or mechanic listed in the above referenced payroll have been paid,
                     (Name of Signatory Party)                                                     (Title)
                                                                                                                                                         as indicated on the payroll, an amount not less than the usm of hte sapplicable
                                                                                                                                                         basic hourly wage rate plus the amount of the required fringe benefits as listed
do hereby state:
                                                                                                                                                         in the contract, except as noted in Section 4(c) below.
       (1) That I pay or supervise the payment of the persons employed by
                                                                                                                                        (c) EXCEPTIONS
                                                                                                                        on the
                                          (Contractor or Subcontractor)

                                                                             that during the payroll period commencing on the                    EXCEPTION (CRAFT)                                        EXPLANATION
                     (Building or Work)

            day of                           ,          ,   and ending the                day of                    ,           ,
all persons employed on said project have been paid the full weekly wages earned, that no rebates
have
been or will be made either directly or indirectly to or on behealf of said
                                                                                           from the full
                                             (Contractor or Subcontractor)


weekly wages earned by any person and that no deductions have been made either directly or
indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations,
Part
3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended (48 Stat




                                                                                                                                    REMARKS:


     (2) That any payrolls otherwise under this contract required to be submetted for the above period
are
correct and copmlete; that the wage rates for laborers or mechanics contained therein are not less than
the
applicable wage rates contained in any wage determination Incorporated into the contract; that
     (3) That any apprentices employed in the above period are duly registered in a bona
fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau
of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in
       (4) That:
             (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS                                                NAME AND TITLE                                   SIGNATURE


                              in addition to the basic hourly wage rates paid to each laborer or mechanic listed
                              in
                              the above referenced payroll, payments of fring benefits as listed in the                             THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
                              contract                                                                                              SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF
                                                                                                                                    TITLE
                              have been or will be made to appropriate programs for the benefit of                                  3 i OF THE UNITED STATES CODE.


                                                                                                                                                                                                                          * U.S. G.P.O.: 1997 519.861

				
DOCUMENT INFO
Description: Subcontractor Payroll document sample