23_PW_CERTIFIED_PAYROLL_REPORT_-_OHIO_(2024.12.27).pdf
PDF 55 KB Posted
- Solicitation number
- AR2608
- Issued by
- Cuyahoga County, Ohio
About this file
This is a Certified Payroll Report document submitted to the State of Ohio for the Michael J. Zone Neighborhood Resource & Recreation Center Locker Room, Entrance Lobby, & Restroom Improvements project administered by the City of Cleveland's Mayor's Office of Capital Projects (MOCAP). The report documents prevailing wage compliance and labor tracking for construction workers employed on the project, including worker classifications, hours worked, and wage rates paid in accordance with prevailing wage requirements applicable to public works projects in Ohio. The certified payroll report serves as evidence of contractor compliance with federal and state prevailing wage laws and regulations governing public construction projects.
The report captures payroll data required for project oversight and audit purposes, ensuring that all workers on the Design-Build project receive wages meeting or exceeding established prevailing wage standards. This documentation is essential for public accountability and regulatory compliance on City-funded capital improvement projects managed through MOCAP's Division of Architecture and Site Development. The certified payroll submission demonstrates the contractor's adherence to labor standards and provides the municipality with verifiable evidence of proper wage payment throughout the project's construction phase.
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Text version
F330-03Av0612 1If Subcontractor, provide Contractor name in space provided. 2Attach additional pages as necessary. 3Text will wrap. 4Text will fit to cell.
My signature on this form signifies that I pay, or supervise the payment of the employees shown above. I am certifying: 1) That during the pay period reported on this form, all hours worked on this Project have been paid at the appropriate prevailing wage rate for the class of work done. 2) That the fringe benefits have been paid as indicated above. 3) That no rebates or deductions have been or will be made, directly or indirectly from the total wages earned, other than permissable deductions as defined in Ohio Revised Code Chapter 4115. 4) That apprentices are registered with the U.S. Department of Labor, Bureau of Apprenticeship and Training. I understand that the willful falsification of any of the above statements may subject the Contractor or Subcontractor to civil or criminal prosecution. In addition, I have submitted the full Name, Social Security Number, and Address of each Worker on a separate sheet (Part B) to form the entire Certified Payroll Report required by Applicable Law.
Signature: Date:Type or Print Name and Title:
ST
OT
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ST
ST
OT
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ST
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OT
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9. TTL
HRS
ALL
JOBS
7.
PROJ
GROSS
WAGES
W TH F
PAYROLL NUMBER
S of
Certified Payroll Report - Part A 330 Construction Contractor Payment State of Ohio Standard Forms for Public Facility Construction
11.
TAXES
WITH-
HELD
12.
OTHER
DEDUC-
TIONS
13.
NET
WAGES
PAID
APP OTHER
CASH8. FRINGES:
APPROVED PLANS
CASH AND APPROVED PLANS
PENS
M T
VAC
S
4. HOURS WORKED - DAY AND DATE
1. NAME AND INDIVIDUAL
IDENTIFYING NUMBER (e.g., LAST
FOUR DIGITS OF SOCIAL SECURITY
NUMBER) OF WORKER
2. WORK
CLASS-
IFICA-
TION
3.
RACE
AND
SEX
H&W
OT
ST
10. TOTAL
GROSS
ALL JOBS
5.
TOTAL
PROJ
HRS
6.
BASE
WAGE
RATE
PAGE2
EMPLOYER NAME AND ADDRESS NAME OF GENERAL / PRIME CONTRACTOR PROJECT NAME AND LOCATION (COUNTY) CONTRACTING AUTHORITY (OR OWNER)
PROJECT / CONTRACT NUMBERWEEK ENDING CHECK IF SUBCONTRACTOR1
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F330-03Bv0612 1If Subcontractor, provide Contractor name in space provided. 2Attach additional pages as necessary. 3For Public Records Requests, redact Social Security Numbers.
FULL NAME OF WORKER SOCIAL SECURITY NUMBER3 STREET ADDRESS CITY, STATE AND ZIP CODE of
CHECK IF SUBCONTRACTOR1 WEEK ENDING PAYROLL NUMBER PAGE2 PROJECT / CONTRACT NUMBER
Certified Payroll Report - Part B 330 Construction Contractor Payment State of Ohio Standard Forms for Public Facility Construction EMPLOYER NAME AND ADDRESS NAME OF GENERAL / PRIME CONTRACTOR PROJECT NAME AND LOCATION (COUNTY) CONTRACTING AUTHORITY (OR OWNER)
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