Project & Contractor

Contractor / Subcontractor name

Address

This payroll is for a

Payroll No.

Week ending (MM/DD/YYYY)

Project & location

Project or contract no.

Week ending sets the 7 day-column dates automatically (the week ending on that date).

Employees & Hours

Employees: 0

Total straight hrs: 0

Total OT hrs: 0

Total gross this week: $0.00

Signatory name

Title

Date signed (MM/DD/YYYY)

Fringe benefits — choose how paid

(a) Fringe benefits paid to approved plans, funds, or programs

(b) Fringe benefits paid in cash (included in the rates above)

Exceptions (if any)

Remarks