Weekly Statement of Compliance and Certified Transcript of Payroll Contract No. Contractor or Subcontractor & No. Airport Payroll No. IL Project No. Federal Project No. For Week Ending Address No Work Suspended Completed (11) (1) (2) (3) (4) (5) (10) (6) (7) (8) (9) St Deductions Name and Individual or Hours and Days Worked Total Rate Amount Total Wages Identification Number OT Hours of Pay Earned Earned Federal State Total Paid for FICA Other WH Tax WH Tax Deduction Week S 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 The submitted payrolls shall be initialed and dated by the Resident Engineer, as an acknowledgment of the date and submission of the payrolls. Resident Engineer Date * See instruction page for codes to be entered NOTE: A certified copy of each weekly payroll must be submitted by the prime contractor within seven (7) days of the regular payment date.
Weekly Statement of Compliance and Certified Transcript of Payroll Contractor or Subcontractor & No. Airport Contract No. Payroll No. Address IL Project No. Federal Project No. For Week Ending No Work Suspended Completed (1) (2) (3) (4) St (5) (6) (7) (8) (9) (10) (11) Name and Individual or Hours and Days Worked Total Rate Amount Total Deductions Wages Identification Number OT Hours of Pay Earned Earned Federal WH Tax FICA State WH Tax Other Total Deduction Paid for Week S 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 S 0.00 0.00 0.00 0.00 O 0.00 0.00 0.00 0.00 The submitted payrolls shall be initialed and dated by the Resident Engineer, as an acknowledgment of the date and submission of the payrolls. Resident Engineer Date * See instruction page for codes to be entered NOTE: A certified copy of each weekly payroll must be submitted by the prime contractor within seven (7) days of the regular payment date.
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