Lco Form 8 - Employee Pay Restitution Worksheet
Download a blank fillable Lco Form 8 - Employee Pay Restitution Worksheet in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Lco Form 8 - Employee Pay Restitution Worksheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Employee Pay Restitution Worksheet
1. Name of Company: _____________________________
2. Name/Title of Person Completing This Report: ________________________________________________
(Printed Name)
(Title)
3. Phone Number: _____________________ Fax: ______________________
4. Name of Project: ______________________________
Project #: ____________________
5. Payroll Week Ending: __________________________
6. How Restitution Originated: ____ On Site Review ____ Self-identified _____USDOL Higher Rate Stipulated
7. Employee: ______________________________
________________________________
Name
Work Classification
8. Total Hours Worked:
S/T: _______________________ O/T: _________________________
9. Original Payment Breakout (amount appearing on payroll the worker was previously paid):
a. Straight Time Paid: _________________ @ _____________ = ______________
Number Hours
Pay Rate
Sub-Total
b. Overtime Paid: _________________ @ _____________ = ______________
Number Hours
Pay Rate
Sub-Total
10. Revised/Corrected Payment Breakout (show the amount the worker should have been paid):
a. Straight Time Paid: _________________ @ _____________ = ______________
# Hours
*Pay Rate
Sub-Total
b. Overtime Paid: _________________ @ _____________ = ______________
# Hours
**Pay Rate
Sub-Total
11a. Amount Previously Paid: $ ______________ 11b. Revised Amount: $ ________________
(Gross)
(Gross)
12. TOTAL AMOUNT DUE EMPLOYEE (this classification): (11b minus 11a): $ _____________________
(Gross)
CERTIFICATION: This is to certify that a check in the amount of $ ________________ (net) was provided to the
person identified on line 7 above on ___________________. A copy of the restitution check. The amount paid
includes overtime computed at a rate of one and one half times the base pay rate due the employee according to the
Contract & Davis-Bacon Act. I understand that a separate worksheet must be completed on each employee, for
each payroll period in question (one restitution check can be used). The total above represents the full amount due
the employee.
________________________________
_________________
Signature
Date
* This amount must, at a minimum, be equal the base rate + fringe rate stated in the Wage Schedule. You may deduct from this amount the hourly
fringes paid to the employee by attaching a Fringe Benefit Breakout Report.
** The overtime rate shall be the sum of the base rate, plus half of the base rate, plus the required fringes at the straight time rate:
((Base rate X 1.5) + fringe amount) - (applicable hourly fringes from attached Fringe Benefit Breakout Report)) = minimum overtime rate
LCO Form 8 (Rev: Oct 07)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business