Form Llc-25 - Weekly Payroll Certification For Public Works Projects

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WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS
Contractor or
Subcontractor (Please check one)
ALL INFORMATION MUST BE COMPLETED
CONTRACTOR
SUBCONTRACTOR
ADDRESS
ADDRESS
BUREAU OF LABOR LAW COMPLIANCE
PAYROLL NUMBER WEEK ENDING DATE
PROJECT AND LOCATION
PREVAILING WAGE DIVISION
7TH & FORSTER STREETS
HARRISBURG, PA 17120
PROJECT SERIAL #
PROJECT #
1-800-932-0665
DAY AND DATE
S-
TOTAL FRINGE
GROSS PAY
APPR.
BASE
WORK
TOTAL
BENEFITS
FOR
RATE
TIME
EMPLOYEE NAME
HOURLY
CLASSIFICATION
DEDUCTIONS
CHECK #
(C=Cash)
PREVAILING
0-
(%)
RATE
TIME
(FB=Contributions)*
RATE JOB(S)
HOURS WORKED EACH DAY
C:
FB:
C:
FB:
C:
FB:
C:
FB:
C:
FB:
*SEE REVERSE SIDE
PAGE NUMBER ___________ OF ____________
LLC-25 REV 10-03 (Page 1)
15a

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