1. finance
2. personal finance
3. financial planning
4. retirement and pension

.
INSTRUCTIONS FOR COMPLETING
PUBLIC WORKS PAYROLL REPORTING
(SAMPLEATTACHED)
All payroll reports may be completed on ilie attached form or any oilier document as long as
the format contains the following information:
(1) Name. Address. and SS#: The addressand SS# needonlY to be shownon the}irst
certijiedp~roll that the employee
appear,althoughthe namesof eachemployeemust be shown
on all of thep~rolls. This informationmust not be obliterated,as Keenan& Associatesis a
Third Par(yAdministratorrepresentingtheSchoolDistrict.
(2) No of withholding exemptions: Self-explanatory.
(3) Wark Classification;
CfrJjt of work beingpetjof7l1ed as shown on the Department oj
Industrial Relations website. When the craft of the worker is not listed in the wage
detef7l1inationthe most closelYrelated craft or trade will bepaid. The detef7l1inationof the craft
will be the Department of Industrial Relations or the awarding body labor complianceprogram.
(4) Weekending: Indicatethe work weekdateswith the cofTCsponding
dCfYs.
Hours Worked Each Da~: Number of straight time and overtimehoursworked on this
Projectby dCfJ.Do not includethe hoursworkedon otherprojects.
(5) Total Hours: The numberof total hoursworkedas notedfor theweek.
(6) Hourly Rate of Pa~: The rate of pay by craft as indicatedon the website. Either the
rate ofpay will be the basicrateofpay and will accompanyafringe benefitstatementto define
the amount of benefitsor the loadedrate will be shownindicating that thefringe benefitsare
beingincludedin theemployees
rateofpay.
(7) Gross Amount Earned: This Project- the total amountof moniesearnedonlYon this
project. All Projects-Should matchyour payroll ledgerand will includethegross amount of
monies paid to the employee
for the entire week of work performed on all projects.
(REMENBERANYTHING TO mE LEFT OF mE PAG.$ FROM 'THIS
PROJECT"
WILL
REFLECT
WORK PERFORMED
ON
mE
SCHOOL
PROJECT. mE RIGHT SIDE ':ALL PROJECTS"WILL MATCH YOUR
WEEKLY PAYROLL LEDGER
(8) DEDUCTIONS.
CONTRIBUTIONS
AND PAYMENTS:
Any deductions
takenfrom the employees
pay which are standarddeductionsor otherdeductionstaken with a
signedauthorizationfrom the employee.If any employeehas a courtordereddeductionplease
explain on the Statementof Compliancewith must be attachedto eachof the weeklYpayrolls.
(9) Net WagesPaid for Week & CheckNumber: Se!fexplanatory.
Each contractor must complete a Payroll Report even when no work was performed on the
project for that week. The payroll form must state there was no payroll for that period. A
final payroll for all contractors must be submitted and marked as "Final" when their work is
completed on the Project.
~ote: Each p.rime contrac~~r(s)is respon~ible for ensurin~ that all its subbontractor~ of any
tier comply With the prevailing wage requtrements.The pnme contractor I~ust mOnitor the
subcontractors' payment of the specified general prevailing wages to their employees by
periodically reviewing the subcontractors' Certified Payrolls. Upon becoming aware that a
subcontractor has failed to apply the specified prevailing rate of wages,th~ prime contractor
must take corrective action to halt or rectify the failure, including, b'ft not limited to,
reta.ining sufficient hmds due the suhcontractor for work performed on the p1-1hlic'.vorks
proJect.
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N OTI CE TO PUBL.I CENT.ITY
For Privacy Considerations
Fold back along dotted line prior to copying for release to general public (private persons).
(PaperSize then 8-1/2 x 11 inches)
, the undersigned,am the
I,
(Name -print)
(Position in business)
with the authority to act for and on behalf of
(Name
ofbusiness
and/orconlr3ctor)
, certify under penalty of perjury
that the records or copies thereof submittedand consisting of
(Description.numberof pages)
are the originals or true, full, and correctcopies of the originals which depict the payroll
record(s) of the actual disbursementsby way of cash, check or whatever fonn t(j)the individual or
individuals named.
Date:
Signature:
11
A public entity may require a stricter and/ormore extensive form of certification.
October2003
.I
INSTRUCTIONS FOR COMPLETING
FRINGE BENEFIT STATEMENT
(SAMPLE ATTACHED)
This
paid
in form
the
must
cash
each be
to
company
and
included
employee.
must
with
be
the
The
the
first
fo1:tn
original
must certified
payroll
signed
be
report a
by
if
responsible
fring
j
representative
benefits
are
not
of
signature.
Contract Nwnber: SchoolDistrict
Contract Location:
Site of theProject
Contractor/Business
Address: Physicaladdressofbusiness,noIP.O. Box
All of the following are from the Department of Industrial Relations Website b~
Craft:
Classification: All craftsof employees
thatyou haveworking on the Project.
Effective Date: The dateof the wagedetermination
for fiinge benefitsby craft.
Subsistence or Travel Pay: The amount shownin the wagedecisionof the craft of 1,;orkersthat require
subsistence
or travel at theProjectlocation.
Fringe Benefits: The amountoffringe benefitsthat arepaid by craft. -if any monies4repaid on behalfof
the employees
thry must be authorizedin writing.All methodsofpqymentmustbeshownlontheform
1
Paid To: Inset1 the nameand addressof the Plan where the moniesare beingP 11 (Do not list the
employees'
names,onlYwherethe moniesare going)
~
If
your
the
their
wage
Remember
you
do
total
own
web
not
make
your
amountbenefit
site.
shown
program
If
the
determination
any
benefit
paid the
Department
on
difference
then
that
fringe
on
Pension
in
the
payments
behalf
the
to
of your
amount
difference
Fund
of
of
must
payments
be
must
Industrial
the
local
employees,
your
Relations
union
as
program
paid
to
be
irrevocably
trust
long
is
the
Wage
fund
as
less
the Decisio
than
employee
to
part
a
"Third
may
j
the
as
paid
you
amO
ts
that
a
as
do
unt
e
arty
still
is
not posted
shown
basic
on
in
wage
Trust"
claim
exceed
the
rate.
Contract
Today's
KEENAN & ASSOCIATES
CONTRACTOR
Contract Number I Name:
Contractor
I Subcontractor
FRINGE BENEFIT STATEMENT
Location
Date:
Name:
In order that the proper Fringe Benefit rates can be verified when checking payrolls on the above contract, the hourly
rates for fringe benefits. subsistence and/or travel allowance payment made for employees on the various classes of
work are tabulated below.
,
Classification:
'.
Eff~l.Ve Date.
Travel Pay
$
.i:i:
Health &
vVeifare
$
Pension
$
,0:
C/)
PAlbto:
w
Name:
Addre$s:
Z
!J.J
m
Vacation!
w
(!)
Holiday
~
Training
Z
LJ..
Name:
Address:
$
PAID TO:
N~me:
Address;
c
Name:
$
..~
and/or Other
AdQr~s$:
Classification:
Travel Pay:
$
Health &
$
pAIDi'd:
Welfare
U)
Pension
I-
~W
P;Ai1bTO:
Z
W
Vacationl
co
w
PAID TO:
Name
Addres:s
Name:
d
"s.'
A
" dr'e""
~,;I""'
Name
C)
Holiday
Addr~$s
u..
Training
And/or Other
Name
Address"
~
~
"
"
Classification
rravel Pay
$
Health &
Welfare
$
PAJ.Dro
Name
Address
(/)
l-
Pension
ll:
$
PAlaTa:
w
z
w
m
w
Vacation!
(!)
Holiday
Z
~
U-
Name:
Address::pAfoTO:
Training
And/or Other
Supplemental
Narl1~:
Address:
$
$
PAID TO:
'"""'(""""",..".,..
Name
Addre$$
statements must be submitted during the progress of work should a change in rate of any of the classifications
be made.
c';;
2.
INSTRUCTIONS FOR COMPLETING FORM CACF2
APPRENTICE TRAINING CONTRIBUTION
I
(SAMPLE ATTACHED)
The Director of Industrial Relations using apprentice wage standard~ set forth in the
collective bargaining agreement and/or approved by the California! Apprenticeship
Council shall determine the apprenticeship rate of pay.
An~ Contractor or
subcontractor performing work on a public works contract must PfY training fund
contributions or apprenticeship contributions in one of the following manners:
Joint Apprenticeship Program Trost Fund for c~ch cr~ft in the site of the
project site.
If the Joint Apprenticeship Program is unable Ito accept the
contributions an eq~ivalent amount shall be paid td the California
Apprenticeship
Council (CAC) administered by !the California
Department of Apprenticeship Standards.
I
3.
If neither of the above will accept the funds, cash pay shall be in
accordance with the following:
California Code of Regulations Section 16200(a)(3)(1)
Cash payments to the employee can only occur wh~n their craft or
trade is designated as non-apprentice able by the IDepartment of
Industrial Relations. This applies as well to contraqtors employing
owner-operators, sole proprietors, and partners.
In order to determine the applicable prevailing wage tate for each I apprentice you
may refer to the Director of the Department of Industrial Relations prevailing wage
determinations for apprentices on the DIR Website.
I
Training contributions to the Joint Apprenticeship Council are due land payable on
the 15thday of each month for work performed during the preceding ~onth.
Training contributions to the C~lifomia Apprenticeship
check and shall accompany a completed CAC-2
Contributions."
Council s\tall be paid by
Form, "training
Fund
!
A copy of the completed CAC-2 form or a letter from the aripropriate Joint
Apprenticeship Council shall be submitted to Keenan & Associates for each month,
or portion, that employees were dispatched to the Project.
NAME
SIGNATURE
TITLE
State of California
Department of Industrial Relations
California Apprenticehip
Council
P. o. Box 420603
San Francisco, CA 94142
Please use a separate form for each jobsite,
listing the occupations for the jobsite. One check
payable to the California Apprenticeship Council, may be
submitted for all jobsites and/or occupations. Training
fund contributions are not accepted by the California
Apprenticeship Council for federal public works projects,
or for non-apprenticeable occupations such as utility
technicians, teamsters, etc.
-NAME
AND ADDRESS OF CONTRACTOR/SUBCONTRACTOR MAKING CONTRIBUTION
TRAINING
FUND CONTRIBUTIONS
California Apprenticeship
Council
CONTRACTOR'S LICENSE NMBER
CONTRACT OR PROJECT NUMBER
JOBSITE lOCATION (INCLUDE COUNTY) IF APPLICABLE.
GIVE NAME OF SCHOOL, HOSPITAL, BUilDING. ETC.I
AND ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT
!PERIOD COVERED BY CONTRIBUTION (FROM-TO)
CLASSIFICATIONS) OF WORKERS(CARPENTER, PLUMBER. ELECTRICIAN. ETC.)
COUNTVWORK PERFORMED IN
HOURS
CONTRIBUTION
RATE PER HOUR
AMOUNT
0.00
0.00
...",
0.00
0.00
0.00
0.00
0.00
Total
DAtE
PLEASE TYPE OR PRINT YOUR NAME
AREA CODE & TELEPHONE NUMBER
CAC 2 (rev. 6/03\ HQtrs.
TRAINING FUND CONTRIBUTIONS
$0.00
(SAMPLE ATTACHEU)
Contractors who are not already approved to train by an apprenticeship 1?rogramshall
provide contract award information to all of the applicable apprenticeshiiPcommittees
whose geographic area of operation includes the area of the public works project. Each
Contractor must submit contract award information to the appropriate a{1prenticeship
committee for each apprenticeable craft or trade in the project in the are~. (Section230,Title
8, CaliforniaCodeof Regulations)
The contract award information must be in writing on Form DAS 140, "public Works
Contract ",~\'(ardInformation". The information shall be provided to the applicable
apprenticeship committee within ten (10) days of the date of the executi~n of tile prime
contract or subcontract, but in no event later than the first day in which $e contractor has
workers employed upon the Project. r;5'eclion
230,Title8, C,lliforniaCodea/Regulations}
Completing the fonn "Public Works Contract Award Infoffilation" will ~rovide the
infonnation required pursuant to California Labor Code Section 1777.5. I
After completing the form please submit a copy to Keenan & AssociateslLabor
Compliance Program.
In accordance with Title 8, California Code of Regulations, Section 230.11(a)
Each contractor must employ registered apprentices on the publib works project
in a ratio of no less than one (1) hour of apprentice work for eve~yfive (5) hours
performed by a journeyman.
All contractors must request dispatch of required apprenticesfro~ an
Apprenticeship Program (for each apprenticeable craft or trade)iby giving the
Program actual notice of at least 48 hours (excluding Saturdays,!Sundays and
Holidays) before the date on which apprentices are required. Cgntractors who
are no, already p~rticipating in an approved program and who ~id not rec~ive
sufficient number of apprenticesfrom their initial request dispatdh of apprentices
from at least one other Apprenticeship Committee, if more than one exists in the
area of the Project.
PUBLIC WORKS CONTRACT AWARD INFORMATION
Contract award information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you
must send the information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site
of the public work. Go to: http://www.dir.ca.gov/das/PublicWorksForms.htm for information about programs in your area and trade. You may
also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under
California, State of, Industrial Relations, Division of Apprenticeship Standards.
Do not send this form to the Division
of Apprenticeship
-
Standards.
CONTRAqrOR'S STATE LICENSE NO
NAME OF YOUR COMPANY
AREACODE&TELEPHONE
NO.
MAILINGADDRESSNUMBER& STREET,CITY,ZIP CODE
DATEYOURCONTRACT
EXECUTED
NAME& ADDRESS
OF PUBLICWORKSPROJECT
DATEOFEXPE~D OR ACTUAlSTARTOF PROJECT
-rnIMATED
NAME& ADDRESS
OF PUBLICAGENCYAWARDING
CONTRAGf
N\JMBER
OFJOURNEYMEN
HOURE
OCClJPA"IlON
OFAPPRENTICE
ESTIMATED NUMBER OF APPRENTICE HOURS
(NAME & ADDRESS OF APPRENTICESHIP PRQ9~
APPROXlMA.TEDATES TO BE EMPLOYED
This is not a request
for dispatch
of apprentices.
Contractors must make a separate request for actual dispatch, in accordance with Section 230.1 (a) California Code of Regulations
Check One Of The Boxes Below
1.0
2.0
We will comply with the standards of
3.0
We will employ and train apprentices in accordance with the California Apprenticeship Council regulations,
including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to
perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all
Apprenticeship
Committee for the duration of this job only.
Enter name of t~e Committee
times work with or under the direct supervision of journeyman/men.
Signature
Typed Name
Title
DAS 140(REV. 1/04)
~RMISBEjNGSENtTO:
State of California -Department of Industrial Relations DIVISION
OF APPRENTICESHIPSTANDARDS
D~te
Address:
Address:
REQUEST FOR DISPATCH OF AN APPRENTICE
Do not sendthis form to DAS
You may use this form to request dispatch of an apprentice from the Apprenticeship
Committee
in the craft or trade in the area of the public work. Go to:
htt:
www.dir.ca. ov daB PublicWorksForms.htm for information about 11>rogramsin
your area and trade. You may also consult your local Division of Apprenticeship
Standards (DAS) office whose telephone number may be found in your local directory
under California, State of, Industrial Relations, Division of Apprenticeship Standards.
Date
To Applicable Apprenticeship
Committee
Telephone:
Fax:
Contractor Requesting Dispatch:
Telephone
Fax
Person making request
Number of Apprentice(s) Needed
Date Apprentice(s) to Report
Craft or Trade(48 hours notice required)
Name of Person to Report to
Address to Report to:
Time to Report
You may use this fonn, or make a verbal or written request,to ask for the dispatch of an
apprentice. Pleasetake note of California Code of Regulations, Title 8, § 230.1 (a) which
says in part: if in response to a written reQuest an Apprenticeship Committee does not
dispatch any apprentice to a contractor who has agreed to employ and train apprentices
in accordance with either the Apprenticeship Committee's Standards or these
regulations within 72 hours of such request (e.xcludingSaturdays, Sundays and holidays)
the contractor shall not be considered in violation of this section as a result offailure to
employ apprentices ...
DAS142 (Rev. 9-03)
[SIGNATURE
STATE OFCAL/FORNIA'
OWNER-OPERATOR
LISTING STATEMENT OF COMPLIANCE
Date
do hereby state:
on the
, that during the payroll period commencing
(Bvilding orworl<)
and ending the
full
weekly
-""
sums
earned,
day of
that no rebates
~~,~--",...
:
have been
--"--".~
on the
.all persons working
or will be made
either
directly
day of
---
or
from the full weekly sums earned
on said project have been paid the
indirectly
to or on
behalf
of said
by any person and that no deductions
(Contractor or svbcontractor)
have been made either directly or indirectly from the full sums earned
described
by any person,
other than
permissible
deductions,
as
beiow:
(2) That any payrolls or listings or 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.
(4) That
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
0
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll or listings
payments of fringe benefits as listed in the conb"acthave been or will be made to appropriate programs for the benefit of
such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
0
~
Each Laborer or mechanic listed in the above referenced payroll or listings has been paid as indicated on the payroll ~r
listings 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
Remarks:
NAMe AND TtTLE
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Keenan & Associates
EMPLOYEE INTERVIEW: LABOR COMPLIANCE
Cc.,..
B. TASK BEING PERFORMED
AT TIME OF ItffERVIEW
(INDICA TAREA QUE Ef5TAS HACIENDO DURANTE ENTREVISTA)
C. DO YOU' WORK OVERTIME
(fRABAJAS HORAS EXrRAS)
FR~Q
DYES
.ARE YOU PAID TIME AND ONE.HALF
,
c
DNO
D'
-(CONFRIi;QUEiNCIA)
FOR OVERTIME
PAGAN TIEMPO Y MEDIO POR LAS HORA5 EXTRAS)
DYES
0
DNO
SELDOM
(DEi VEl ENCUAHDO)
CJ
JiMR'"
(!'IIi4~CA1'f.c::
'.--"~~
IF NO. EXPLAIN
(51 NO ES ASI. EXPLICATE)
DO YOU KEEP A RECORD OF THE HOURS YOU WORK
CGUARDAS UN EXPEDIENTE
.
DE LAS HORAS QUE TRABAJAS)
DYES
DNO
Rev.06-26-03
MONTHLY
UTILIZATION
REPORT
Month:
A Monthly Utilization Report for the contractor and for each of its subcontractorsis required to
be completed and submitted via fax to Keenan & Associates,Labor Compliance Officer each
month by no later than the fifth day of the month. Reports are to be for the previous month's
work and are to be project specific. If no work was performed during that month, the form shall
clearly state:"No Work."
Contractor:
School District
ProjectLocation:
David Hill
Labor Compliance Officer
Keenan & Associates
Tel: (310)212-0363Ext. 2608
Fax: (310)212-0300
Keenan & Associates
License # 0451271
Contract or Project Number