Form WH-347-Wage report Form-BlanK.xls
XLS spreadsheet 61 KB Posted
- Attached to
- Award to Chance Construction on 22 Aug 09
- Solicitation number
- W912L109R0038
About this file
WAGE REPORT
View the file
Other files
Show all 37
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
front
| U.S. Department of Labor | ||||||||||||||||||||
| Wage and Hour Division | ||||||||||||||||||||
| (For Contractor's Optional Use; See Instruction, Form WH-347 Inst.) | ||||||||||||||||||||
| NAME OF CONTRACTOR OR SUBCONTRACTOR . | ADDRESS | OMB No.: 1215-0149 | ||||||||||||||||||
| Expires: 06-30-97 | ||||||||||||||||||||
| PAYROLL NO. | FOR WEEK ENDING | PROJECT AND LOCATION | PROJECT OR CONTRACT NO. | |||||||||||||||||
| (1) | (2) | (3) | (4) DAY AND DATE | (5) | (6) | (7) | (8) | (9) | ||||||||||||
| NAME, ADDRESS, AND | # OF | ST | M | T | W | T | F | S | S | GROSS | DEDUCTIONS | DEDUCTIONS | NET | |||||||
| SOCIAL SECURITY NUMBER | W/H | WORK | or | TOTAL | RATE | AMOUNT | FICA | WITH- | MEDI- | OTHER | TOTAL | WAGES | ||||||||
| OF EMPLOYEE | Exempt | CLASSIFICATION | OT | HOURS WORKED EACH DAY | HOURS | OF PAY | EARNED | HOLDING | CARE | Deductions | PAID | |||||||||
| TAX | FOR WEEK | |||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| O | ||||||||||||||||||||
| S | ||||||||||||||||||||
| in house reproduction of -- FORM WH-347 (3/91) -- FORMERLY SOL 184-- PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS |
BACK
| Date ______ | contract have been or will be made to appropriate programs for the benefit of | |
| such employees, except as noted in Section 4(c) below. | ||
| I, ____________________________, ________________________________________ | ||
| (Name of signatory party) (Title) | ||
| (b) WHERE FRINGE BENEFITS ARE PAID IN CASH | ||
| do hereby state: | ___ Each laborer or mechanic listed in the above referenced payroll has been paid, as | |
| indicated on the payroll, an amount not less than the sum of the applicable basic | ||
| (1) That I pay or supervise the payment of the persons employed by _____________________ | hourly wage rate plus the amount of the required fringe benefits as listed in the | |
| contract, except as noted in Section 4(c) below. | ||
| __________________________; on the _____________________________________ | ||
| __________ ; that during the payroll period commencing on the ____ . | (c) EXCEPTIONS | |
| day of _____________, 2002, and ending the ____________.day of ____________, 2002, | ||
| all persons employed on said project have been paid the full weekly wages earned, that no rebates | EXCEPTION (CRAFT) | EXPLANATION |
| have been or will be made either directly or indirectly to or on behalf of said | ||
| (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. 948 Stat. 108, 72 Stat. 967; 769 Stat. 357; 40 U.S.C. 276c), and de- | ||
| scribed below: | ||
| (2) That any payrolls otherwise under this contract required to be submitted for the above | REMARKS | |
| period are correct and complete; that the wage rates for laborers or mechanics contained therein | ||
| are not less than the applicable wage ratescontained in any wage determination incorporated into | ||
| the contract; that the classifications set forth therein for each laborer or mechanic conform with | ||
| the work he performed. | ||
| (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 Apprentice and Training, United States Department of Labor, or if no such recognized agency | ||
| exists in a State, are registered with the Bureau of Apprenticeship and Training, United States | ||
| Depatement of Labor. | ||
| (4) That: | ||
| NAME AND TITLE | SIGNATURE | |
| (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS | ||
| THE WILFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR | ||
| ___-- In addition to the basic hourly wage rates paid to each laborer or mechanic | OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND | |
| listed in the above refernced payroll, payments of fringe benefits as listed in the | SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. |
Sheet3
| FINAL WAIVER |
| AFFIDAVIT AND WAIVER OF LIEN |
| PROJECT #: 6128 |
| STATE OF: Texas |
| COUNTY OF: Harris |
| __ Christopher Malcom___ of __LMC CORPORATION____ being first duly sworn, states |
| as follows: |
| 1) I am the __Supervisor_______ (title and/or position) of __ _LMC ______ |
| (hereinafter referred to as "SUBCONTRACTOR") and am familiar with the facts herein stated. |
| 2) SUBCONTRACTOR has performed for LMC CORPORATION, (hereinafter referred |
| to as "CONTRACTOR"), certain labor, and/or furnished certain supplies, materials, equipment |
| and/or facilities for use in the construction of certain buildings and improvements on certain land |
| owned by _______USPFO for Texas________________(hereinafter referred to as "OWNER"), at |
| __________Ellington AFB, Building 1056. |
| 3) SUBCONTRACTOR has paid a FINAL payment for such supplies & materials, |
| equipment and other facilities furnished by it, or by others for it, in connection eith the Project, and |
| FINAL payment has been made by all such others for all supplies, materials, equipment and other |
| facilities furnished by them through week ending ___________________________. |
| 4) SUBCONTRACTOR has no lien or claim rights on account of labor, supplies, materials, |
| equipment or other facilities furnished by it, or by others for it, in connection with the Project. |
| 5) SUBCONTRACTOR hereby waives all liens and claims concerning this FINAL waiver |
| against CONTRACTOR and OWNER, its premises, assets and property. |
| 6) SUBCONTRACTOR will hold OWNER and CONTRACTOR harmless against any |
| and all liens and claims and suits on liens, including all expenses, costs and attorney fees associated |
| herewith, arising out of any labor, supplies, materials, equipment or other facilities furnished by it, |
| or by others for it, in connection with the Project. |
| Further affiant saith not. |
| _______________________________________ |
| SUBCONTRACTOR |
| _______________________________________ |
| DATE |
Sheet4
&A Page &P
Sheet5
Sheet6
Sheet7
Sheet8
Sheet9
Sheet10
Sheet11
Sheet12
Sheet13
Sheet14
Sheet15
Sheet16
File details come from the government source that posted it. Updated .