BUREAU OF LABOR AND INDUSTRIES
PREVAILING WAGE RATE UNIT
INSTRUCTIONS FOR COMPLETING THE PREVAILING WAGE RATE
PAYROLL/CERTIFIED STATEMENT FORM
This form may be used by contractors for reporting their payroll as required by ORS 279C.845 on public works projects subject to the Prevailing Wage Rate Law. Although this form has not been officially approved by the USDOL, it is designed to meet the requirements of the federal Davis-Bacon Act as well. The form contains a certified statement that is required to be signed by the contractor, certifying the accuracy of the information reported on the payroll, including representations pertaining to the provision of fringe benefits to employees by third parties. Contractors are not required to use this form in reporting their payroll; however, the contractor must provide all of the information contained in the form, and the certified statement must be signed and submitted with the contractor’s payroll. Detailed instructions concerning the preparation of the form follow:
Complete the box at the top of the form. Check either the prime contractor or subcontractor box. Be sure to enter the date the contract was first advertised for bid. If you are not sure of this date, contact the Public Contracting Agency.
Column 1 – NAME AND ADDRESS: The employee’s full name must be shown on each payroll submitted.
The employee’s address must also be shown on the first payroll submitted. The address need not be shown on subsequent payrolls submitted unless the address changes.
Column 2 – TRADE CLASSIFICATIONS: List the classification found in the Bureau of Labor and Industries’ publication “Prevailing Wage Rates for Public Works Contracts in Oregon,” that is most descriptive of the
work actually performed by the employee. Give the group number for those worker classifications that include such information. Consult the worker classifications and minimum prevailing wage rate schedule set forth in the contract specifications. Use the appropriate prevailing wage rates in effect at the time the contract was first advertised for bid for information regarding trade classifications, base hourly rates, and hourly fringe benefits. Indicate which workers are apprentices, if any, and give their current percentage, trade classification, and group number when applicable. If an employee works in more than one worker classification, use the highest rate for all hours worked, or use separate line entries to show hours worked, rate of pay, and fringe benefit for each classification.
Column 3 – DAY AND DATE: Enter the day of the week (M, T, W, Th, F, S, and Sn) in the top row of boxes, and the corresponding date below.
HOURS WORKED EACH DAY: Enter the total number of “straight time” hours worked in the row marked “S”.
Hours worked over 8 in a day or work performed on Saturdays, Sundays, and legal holidays should be entered as overtime (“OT”) hours worked. Contractors who have adopted a written work schedule of four consecutive ten-hour days, Monday through Thursday or Tuesday through Friday may enter hours worked over 10 in a day as overtime hours.
Column 4 – TOTAL HOURS: Enter separately the total number of straight time and overtime hours worked by each listed employee and classification during this pay period. The total number of straight time hours worked should be entered in the lower box (“S”); the total number of overtime hours worked should be entered in the top box (“OT”).
Column 5 – BASE HOURLY RATE OF PAY: Enter the base hourly rate and the overtime hourly rate (if any)
paid the employee in the appropriate straight time and overtime boxes. (Payment of not less than one and one half times the base or regular rate of pay, not including fringe benefits, is required to be paid in overtime pursuant to ORS 279C.540).
Column 6 – HOURLY FRINGE BENEFIT AMOUNT PAID AS WAGES TO THE EMPLOYEE: Enter any
additional wages paid directly to the employee in lieu of fringe benefits. (It is not necessary to pay time and a half for overtime work on those wages that are paid in lieu of fringe benefits.)
Column 7 – GROSS AMOUNT EARNED: Enter gross amount earned on this project. If part of the
employees’ weekly wages were earned on projects other than the project described on this payroll, enter in column 7 first the amount earned on the PWR project then the gross amount earned during the week on all projects, thus $63.00/$120.00.
Column 8 – ITEMIZED DEDUCTIONS, FICA, FED, STATE, ETC.: Enter a list of itemized deductions
withheld from the wages of each employee for only those hours reported on this payroll/certified statement for this project. All deductions must be in accordance with the provisions of ORS 652.610 (and 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 Stat. 108, 72 Stat. Stat. 967, 76 Stat. 357; 40 U.S.C 276c) on projects subject to Davis-Bacon Act.)
Column 9 – NET WAGES PAID FOR WEEK: Enter the total amount of net wages actually paid to the
employee after subtracting the total deductions reported in Column 8 from the gross amount earned shown
in Column 7.
Column 10 – HOURLY FRINGE BENEFITS PAID TO BENEFITS PARTY, PLAN, FUND OR PROGRAM:
Enter the hourly amount of fringe benefits paid to each individually approved party, plan, fund or program for each employee. List these amounts separately on the lines provided. Any contractor who is making payments to approved parties, plans, funds or programs on amounts less than the required hourly fringe benefit is obligated to pay the difference directly to the employee as wages in lieu of fringe benefits, and to show that amount in Column 6 of this form.
Column 11 – NAME OF BENEFIT PARTY, PLAN, FUND OR PROGRAM: Enter the name of the party, plan,
fund or program that corresponds to the amount paid as an hourly fringe benefit in Column 10.
In order to determine whether the wages and fringe benefits paid are sufficient to meet prevailing wage rate requirements, the following check may be performed:
1. For each trade classification listed in column 2, compute the sum of:
a) the Base Hourly Rate of Pay (Column 5),
b) the Hourly Fringe Benefit Amount Paid as Wages to Employee (Column 6)
c) and the Hourly Fringe Benefits Paid to Benefit Party, Plan, Fund or Program (Column 10).
2. This sum must equal or exceed the total of the Base Hourly Rate (including zone pay and
special wage differentials, if any) and the Fringe Benefit Amount as they are listed for the
corresponding trade classifications in the appropriate issue of the Bureau of Labor and Industries
publications Prevailing Wage Rates for Public Works Contracts in Oregon and Prevailing Wage
Rates for Public Works Contracts Subject to BOTH the State PWR and Federal Davis-Bacon Act.
IF YOU HAVE QUESTIONS REGARDING COMPLETION OF THIS FORM, CONTACT THE PREVAILING
WAGE RATE UNIT OF THE BUREAU OF LABOR AND INDUSTRIES AT (971) 673-0852.
NOTE: PAYROLL/CERTIFIED STATEMENTS ARE REQUIRED TO BE SUBMITTED TO THE
CONTRACTING AGENCY ONLY.
CERTIFIED PAYROLL AND OTHER FORMS ARE AVAILABLE ON OUR WEBSITE: