WH-347 Davis-Bacon Certified Payroll

U.S. Department of Labor

PAYROLL

Employment Standards Administration
Wage and Hour Division

(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)

NAME OF CONTRACTOR

ADDRESS

NO. OF
WITHHOLDiNG
EXEMPTIONS

NAME, ADDRESS, AND
SOCIAL SECURITY NUMBER
OF EMPLOYEE

(2)

(3)

WORK
CLASSIFICATION

OMB No.: 1215-0149
Expires: 04/30/2009
PROJECT OR CONTRACT NO.

PROJECT AND LOCATION

FOR WEEK ENDING

(4) DAY AND DATE

(5)

(6)

(7)

(9)
(8)
DEDUCTIONS

OT. OR ST.

PAYROLL NO.

(1)

Rev. April 2006

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.

OR SUBCONTRACTOR

HOURS WORKED EACH DAY

TOTAL
HOURS

RATE
OF PAY

GROSS
AMOUNT
EARNED

FICA

WITHHOLDING
TAX

OTHER

NET
WAGES
TOTAL
PAID
DEDUCTIONS FOR WEEK

O

S

O

S

O

S

O

S

O

S

O

S

O

S

O

S

The Copeland Act (40 U.S.C. 3145) requires contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee during the
preceding week." U.S. Department of Labor (DOL) Regulations 29 CFR Part 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project, accompanied by
a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed. Compliance
with these requirements is mandatory. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
We estimate that it will take an average of 56 minutes to complete this collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection of information, including suggestions for reducing this burden, send them to the Administrator, Wage and
Hour Division, ESA, U. S. Department of Labor, Room S3502, 200 Constitution Avenue, N. W., Washington, D. C. 20210.

Date

(b) WHERE FRINGE BENEFITS ARE PAID IN CASH

−

I,

(Name of Signatory Party)

(Title)

do hereby state:
(1) That I pay or supervise the payment of the persons employed by

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 hourly wage rate plus the amount of the required fringe benefits as listed
in the contract, except as noted in Section 4(c) below.

(c) EXCEPTIONS
on the

(Contractor or Subcontractor)

EXCEPTION (CRAFT)

EXPLANATION

; that during the payroll period commencing on the

(Building or Work)
day of

,

, and ending the

day of

,

,

all persons employed on said project have been paid the full weekly wages earned, that no rebates have
been or will be made either directly or indirectly to or on behalf of said

from the full
(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,
63 Start. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:

REMARKS:

(2) That any payrolls otherwise under this contract required to be submitted for the above period are
correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the
applicable wage rates contained 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
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in a
State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS

−

in addition to the basic hourly wage rates paid to each laborer or mechanic listed in
the above referenced payroll, payments of fringe benefits as listed in the contract
have been or will be made to appropriate programs for the benefit of such
employees, except as noted in Section 4(c) below.

NAME AND TITLE

SIGNATURE

THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE
31 OF THE UNITED STATES CODE.

* U.S. G.P.O.:1997 519.861