Submit in duplicate with all backup documents.
COST BREAKDOWN
CONTRACTOR NAME
SUB
Bill Subcontractor
LABOR COST
Classification
Certified
Fringe Benefits
Total
Hours
Total
Payroll
(as defined
Hourly
Base Rate *
by L&I) *
Rate
Electrician
$28.56
$10.30
$38.86
32
$1,243.52
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Sub-Total
$1,243.52
Social Security @
6.20%
$56.66
Medicare @
1.45%
$13.25
On Base Labor Rate
Unemployment @
8.20%
$74.94
ONLY
Workmans Compensation @
7.80%
$71.29
Public Liability Insurance @
2.00%
$18.28
Sub-Total
$234.42
** Labor Markup
(
15.00%
)
$221.69
TOTAL LABOR
$1,699.63
MATERIAL COST (attach material list if necessary, insert totals as shown)
Item
Quantity
Unit Cost
Total Cost
See Attached Schedule
$0.00
$0.00
$0.00
$0.00
Sub-Total
$9,806.76
** Material Markup
(
10.00%
)
$980.68
*** Applicable Sales Tax
$588.41
MATERIAL TOTAL
$11,375.85
EQUIPMENT COST (equipment cost for owned equipment (depreciation, insurance, etc.) or documentation
supporting lease of equipment)
Classification
Hour Rate
Hours
Total Cost
Crane Truck
$40.00
4
$160.00
$0.00
Sub-Total
$160.00
PRIME
** Equipment Markup
(
10.00%
)
$16.00
SUB
EQUIPMENT TOTAL
$176.00
LME TOTAL
$13,251.48
CFR/s&s/8-04
Page 2 of 2
38