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with date and signature fields.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},348531,1790673809,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social 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LICENSE NO.:\u003Cbr>\u003Cbr>PAYROLL NO.:\u003Cbr>FOR WEEK ENDING:\u003Cbr>(4) DAY (5) (6)\u003Cbr>\u003Cbr>SELF-INSURED CERTIFICATE NO.:\u003Cbr>WORKERS' COMPENSATION POLICY NO.:\u003Cbr>PROJECT OR CONTRACT NO.:\u003Cbr>PROJECT AND LOCATION: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| (1)\u003Cbr>NAME, ADDRESS AND\u003Cbr>SOCIAL SECURITY NUMBER\u003Cbr>OF EMPLOYEE | (2)\u003Cbr>NO . OF WITHHOLDING EXEMPTIONS | (3)\u003Cbr>WORK\u003Cbr>CLASSIFICATION |  | M | T | W | TH | F | S | S | TOTAL\u003Cbr>HOURS | HOURLY\u003Cbr>RATE\u003Cbr>OF PAY | (7)\u003Cbr>GROSS AMOUNT\u003Cbr>EARNED |  | (8)\u003Cbr>DEDUCTIONS, CONTRIBUTIONS AND PAYMENTS |  |  |  |  |  |  |  | (9) |  |\n|  |  |  |  | DATE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NET WGS\u003Cbr>PAID FOR\u003Cbr>WEEK | CHECK\u003Cbr>NO. |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  | HOURS WORKED EACH DAY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | S |  |  |  |  |  |  |  | 0 |  | THIS\u003Cbr>PROJECT | ALL\u003Cbr>PROJECTS | FED.\u003Cbr>TAX | FICA\u003Cbr>(SOC. SEC.) | STATE\u003Cbr>TAX | SDI | VAC/\u003Cbr>HOLIDAY | HEALTH\u003Cbr>& WELF. | PENSION | |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | O |  |  |  |  |  |  |  |  |  |  |  | TRAING. | FUND\u003Cbr>ADMIN | DUES | TRAV/\u003Cbr>SUBS. | SAVINGS | OTHER* | TOTAL\u003Cbr>DEDUCTIONS |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | S |  |  |  |  |  |  |  |  |  | THIS\u003Cbr>PROJECT | ALL\u003Cbr>PROJECTS | FED.\u003Cbr>TAX | FICA\u003Cbr>(SOC. SEC.) | STATE\u003Cbr>TAX | SDI | VAC/\u003Cbr>HOLIDAY | HEALTH\u003Cbr>& WELF. | PENSION | |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | O |  |  |  |  |  |  |  |  |  |  |  | TRAING. | FUND\u003Cbr>ADMIN | DUES | TRAV/\u003Cbr>SUBS. | SAVINGS | OTHER* | TOTAL\u003Cbr>DEDUCTIONS |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | S |  |  |  |  |  |  |  |  |  | THIS\u003Cbr>PROJECT | ALL\u003Cbr>PROJECTS | FED.\u003Cbr>TAX | FICA\u003Cbr>(SOC. SEC.) | STATE\u003Cbr>TAX | SDI | VAC/\u003Cbr>HOLIDAY | HEALTH\u003Cbr>& WELF. | PENSION | |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | O |  |  |  |  |  |  |  |  |  |  |  | TRAING. | FUND\u003Cbr>ADMIN | DUES | TRAV/\u003Cbr>SUBS. | SAVINGS | OTHER* | TOTAL\u003Cbr>DEDUCTIONS |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | S |  |  |  |  |  |  |  |  |  | THIS\u003Cbr>PROJECT | ALL\u003Cbr>PROJECTS | FED.\u003Cbr>TAX | FICA\u003Cbr>(SOC. SEC.) | STATE\u003Cbr>TAX | SDI | VAC/\u003Cbr>HOLIDAY | HEALTH\u003Cbr>& WELF. | PENSION | |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  | O |  |  |  |  |  |  |  |  |  |  |  | TRAING. | FUND\u003Cbr>ADMIN | DUES | TRAV/\u003Cbr>SUBS. | SAVINGS | OTHER* | TOTAL\u003Cbr>DEDUCTIONS |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nForm A-1-131 (New 2-80)  \nS = STRAIGHT TIME O = OVERTIME  \nSDI = STATE DISABILITY INSURANCE  \n*OTHER – Any other deductions, contributions and/or payments whether or not included or required by prevailing wage determinations must be separately listed. Use extra sheet(s) if necessary  \nCERTIFICATION MUST be completed  \n(See reverse side)  \nNOTICE TO PUBLIC ENTITY  \nFor Privacy Considerations  \nFold back along dotted line prior to copying for release to general public (private persons).  \n(Paper Size then 8-1/2 x 11 inches)  \nI,   , the undersigned, am the (Name – print)  \n  with the authority to act for and on behalf of (Position in business)  \n  , certify under penalty of perjury (Name of business and/or contractor)  \nthat the records or copies thereof submit","cbCaiePfNiXlHGcq","https://ap.wps.com/l/cbCaiePfNiXlHGcq","pdf",162356,"English","# Payroll Information\n## Contractor and Project Details\n## Employee Hours, Rate, Earnings, and Deductions\n## Certification and Privacy Notice","[{\"question\":\"What payroll details must be reported on the form?\",\"answer\":\"The form requires weekly employee information such as name, address, Social Security number, withholding exemptions, work classification, daily hours, hourly rate, gross amount earned, and itemized deductions, contributions, and payments.\"},{\"question\":\"What identification fields are needed for the contractor, project, and licensing?\",\"answer\":\"It collects the contractor or subcontractor name and license numbers, workers’ compensation policy and certificate numbers, specialty license numbers, project or contract number, and project and location information.\"},{\"question\":\"What does the certification section require?\",\"answer\":\"The undersigned certifies under penalty of perjury that the submitted records are original or true, full, and correct copies depicting the actual disbursements to the named individuals, with date and signature fields.\"}]","PUBLIC WORKS PAYROLL REPORTING FORM - Form A-1-131 | PDF",1790074401]