Contractor Payroll Receipt Record (Template).doc

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WTR FOUNTAIN & INSL INST
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N0025321Q0046
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CONTRACTOR PAYROLL RECEIPT RECORD

Contract No.
Contract Description & Location

Contractor (Name & Address)

Prime Subcontractor Contractor (Name & Address)

Contractor (Name & Address)

Subcontractor, check if

SF 1413 is submitted Subcontractor, check if

SF 1413 is submitted Subcontractor, check if

SF 1413 is submitted

Payroll #
Weekend-ing Date
Checked By (Initials)
Date Checked
SF 1445 # Conducted
Payroll #
Weekend-ing Date
Checked By (Initials)
Date Checked
SF 1445 # Conducted
Payroll #
Weekend-ing Date
Checked By (Initials)
Date Checked
SF 1445 # Conducted

NOV 2015

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