STATE OF NEVADA

OFFICE OF THE LABOR COMMISSIONER www.labor.nv.gov

WEEKLY WAGE AND HOUR REPORT OF PUBLIC WORK CONTRACTORS FOR THE PAYROLL PERIOD ENDING: , . Month and Day Year

Pursuant to Chapter 338 of Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC), respectively, the contractor and each subcontractor shall keep or cause to be kept an accurate record showing the name and the actual per diem, wages and benefits paid to each workman employed by him in connection with the public work. The contractor or subcontractor shall ensure that a copy of the record for each calendar month is received by the public body awarding the contract no later than15 days after the end of the month.

Report # Regular Weekly Report Final Report for Project Bid/Project # PWP-

Project Title Prime Contractor Name & Address

Public Body Awarding Contract License #

Subcontractor Name & Address License # Report Hours For Above Referenced Public Works Project Only

Employee Name & State/Jurisdiction that issued

Identification

Work Classification

Hours Worked By Day Hourly Bona Fide Fringe Benefit Contribution Net

Wage Paid

S M T W T F S Total Hours

For Week

Hourly Rate

Of Pay H & W Pen. Vac. App.

Trg Other

Gross Amount

Earned For Week For Week

S

O

S

O

S

O

OLC Rev 6/2019

http:www.labor.nv.govhttp:www.labor.nv.gov

Employee Name Work Classification

Hours Worked By Day Total Hours

For Week

Hourly Rate

Of Pay

Hourly Fringe Benefit Contribution Gross

Amount Earned For

Week

Net Wage Paid

For Week

S M T W T F S H & W Pen. Vac. App. Trg

Other

S

O

S

O

S

O

S

O

S

O

S

O

S

O

OLC Rev 6/2019

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________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

__________________________________________ ___________________________________ ___________________

STATE OF NEVADA Office of the Labor Commissioner

STATEMENT OF COMPLIANCE

In compliance with the provisions of Chapters 338 of NRS and NAC, respectively, I, as an officer, owner or director of the undersigned contractor/subcontractor, hereby certify that this report is a true and accurate statement of the worker(s) per diem, wages, and benefits employed on this Public Works Project contract by the undersigned contractor/subcontractor for the following payroll period:

__________________________________________________ to ____________________________________________________ . , , Month and Day Month and Day Year Year

I further certify:

1. That no deductions have been made from the wages earned by any person so listed other than those permissible or required by law. 2. That any apprentice listed herein is registered in a bona fide apprenticeship program. 3. Check all that apply:

The contractor or subcontractor is signatory to a Collective Bargaining Agreement (CBA) with some or all of its employees and bona fide fringe benefits and/or contributions have or will be made not less than monthly in the name of the employee by the contractor or subcontractor as provided for in the CBA.

Each employee listed that is not covered by a Collective Bargaining Agreement (CBA) has been paid the required applicable wages, plus the amount of bona fide fringe benefits listed not less than monthly by the contractor or subcontractor and the bona fide fringe benefit amounts have been annualized by the contractor or subcontractor.

Each employee listed has been paid the required applicable wages per hour with no bona fide fringe benefit contributions paid by the contractor.

Prime Contractor Subcontractor

Contractor Name: Address:

Telephone: Fax:

PRINTED NAME/TITLE SIGNATURE DATE

NRS 338.070:

4. The contractor and each subcontractor shall keep or cause to be kept an accurate record showing the name and the actual per diem, wages and benefits paid to each workman employed by him in connection with the public work.

5. The record must be open at all reasonable hours to the inspection of the public body awarding the contract, and its officers and agents. The contractor or subcontractor shall ensure that a copy of the record for each calendar month is received by the public body awarding the contract no later than 15 days after the end of the month. The copy must be open to public inspection as provided in NRS 239.010. The record in the possession of the public body awarding the contract may be discarded by the public body 2 years after final payment is made by the public body for the public work.

6. Any contractor or subcontractor, or agent or representative thereof, performing work for a public work who neglects to comply with the provisions of this section is guilty of a misdemeanor.

OLC Rev 6/2019

Regular Weekly Report: OffFinal Report for Project: OffPWP: Project Title: Public Body Awarding Contract: Prime Contractor Name Address: OffSubcontractor Name Address: OffGross Amount Earned For WeekRow2: Gross Amount Earned For WeekRow3: The contractor or subcontractor is signatory to a Collective Bargaining Agreement CBA with some or all of its employees and bona fide fringe benefits andor contributions have or will be: OffEach employee listed that is not covered by a Collective Bargaining Agreement CBA has been paid the required applicable wages plus the amount of bona fide fringe benefits listed not: OffEach employee listed has been paid the required applicable wages per hour with no bona fide fringe benefit contributions paid by the contractor: OffPrime Contractor: OffSubcontractor: OffContractor Name: Address: DATE: Report Number: Subcontractor Name and Address: Prim Contractor Name and Address: PRINTED NAME TITLE: Employee Name Page 1 Row1: Employee Name Page 1 Row2: Employee Name Page 1 Row3: Work Classification Page 1 Row1: Work Classification Page 1 Row2: Work Classification Page 1 Row3: Month and Day: Bid/Project Number: License Number: License Number_2: Total Hours for Week: Total Hours for the Week row 2: Total Hours for the Week row 3: Hourly Rate of pay row 1: Hourly Rate of pay row 2: Hourly Rate of pay Row 3: Gross Amount Earned For Week Row1: Net Wage Paid For Week Row 1: Net Wage Paid For Week Row 2: Net Wage Paid For Week Row 3: OverTime hours Sunday: Straight Time Hours Monday: Straight Time Hours Tuesday: Straight Time Hours Wednesday: Straight Time Hours Thursday: Straight Time Hours Friday: Straight Time Hours Saturday: OverTime hours Monday: OverTime hours Tuesday: Straight Time Hours Monday row 2: Straight Time Hours Monday row 3: Straight Time Hours Tuesday row 2: Straight Time Hours Tuesday row 3: Straight Time Hours Wednesday row 2: Straight Time Hours Wednesday row 3: Straight Time Hours Thursday row 2: Straight Time Hours Thursday row 3: Straight Time Hours Friday row 2: Straight Time Hours Friday row 3: Straight Time Hours Saturday row 2: Straight Time Hours Saturday Row 3: OverTime hours Monday Row 2: OverTime hours Monday Row 3: OverTime hours Tuesday Row 2: OverTime hours Tuesday Row 3: OverTime hours Wednesday row 2: OverTime hours Wednesday: OverTime hours Wednesday row 3: OverTime hours Thursday row 2: OverTime hours Thursday: OverTime hours Thursday row 3: OverTime hours Friday row 2: OverTime hours Friday: OverTime hours Friday row 3: OverTime hours Saturday row 2: OverTime hours Saturday: OverTime hours Saturday row 3: H and W: Pen: Vac: App: Trg: Trg_row 3: Trg_row 2: Trg_row 4: Trg_row 5: Trg_row 7: Trg_row 8: Trg_row 10: Trg_row 9: Trg_row 6:

Other: H and W row 3: Pen_row 3: Vac_row 3: Other_row 2: Other_row 3: OverTime hours Sunday row 2: OverTime hours Sunday row 3: H and W row 2: Pen_row 2: Vac_row 2: Pen_row 4: Pen_row 5: Pen_row 7: Pen_row 8: Pen_row 10: Total Hours For the Week_row 10: Total Hours For the Week_row 9: Total Hours For the Week_row 8: Total Hours For the Week_row 7: Total Hours For the Week_row 6: Total Hours For the Week_row 5: Total Hours For the Week_row 4: Hourly Rate of Pay_row 10: Hourly Rate of Pay_row 9: Hourly Rate of Pay_row 8: Hourly Rate of Pay_row 7: Hourly Rate of Pay_row 6: Hourly Rate of Pay_row 5: Hourly Rate of Pay_row 4: Hourly Fringe Contribution_row 10: Hourly Fringe Contribution_row 9: Hourly Fringe Contribution_row 8: Hourly Fringe Contribution_row 7: Hourly Fringe Contribution_row 6: Hourly Fringe Contribution_row 5: Hourly Fringe Contribution_row 4: Gross Amount Earned For Week_Row 10: Gross Amount Earned For Week_Row 9: Gross Amount Earned For Week_Row 8: Gross Amount Earned For Week_Row 7: Gross Amount Earned For Week_Row 6: Gross Amount Earned For Week_Row 5: Net Wage Paid For Week_Row 10: Net Wage Paid For Week_Row 9: Net Wage Paid For Week_Row 8: Net Wage Paid For Week_Row 7: Net Wage Paid For Week_Row 6: Net Wage Paid For Week_Row 5: Net Wage Paid For Week_Row 4: Work Classification Row 10: Work Classification Row 9: Work Classification Row 8: Work Classification Row 7: Work Classification Row 6: Work Classification Row 5: Work Classification Row 4: Employee Name Row 10: Employee Name Row 9: Employee Name Row 8: Employee Name Row 7: Employee Name Row 6: Employee Name Row 5: Employee Name Row 4: OverTime hours Saturday_row 10: OverTime hours Friday_row 10: OverTime hours Thursday_row 10: OverTime hours Wednesday_Row 10: OverTime hours Tuesday_Row 10: OverTime hours Monday_Row 10: OverTime hours Sunday _Row 10: Straight Time Hours Saturday_Row 10: Straight Time Hours Friday_row 10: Straight Time Hours Thursday_row 10: Straight Time Hours Wednesday_row 10: Straight Time Hours Tuesday_row 10: Straight Time Hours Monday_row 10: Straight Time Hours Sunday_row 10: OverTime hours Saturday_row 9: OverTime hours Friday_row 9: OverTime hours Thursday_row 9: OverTime hours Wednesday_Row 9: OverTime hours Tuesday_Row 9: OverTime hours Monday_Row 9: OverTime hours Sunday_Row 9: Straight Time Hours Saturday_Row 9: Straight Time Hours Friday_row 9: Straight Time Hours Thursday_row 9: Straight Time Hours Wednesday_row 9: Straight Time Hours Tuesday_row 9: Straight Time Hours Monday_row 9: Straight Time Hours Sunday_row 9: OverTime hours Saturday_row 8: OverTime hours Friday_row 8: OverTime hours Thursday_row 8: OverTime hours Wednesday_Row 8: OverTime hours Tuesday_Row 8: OverTime hours Monday_Row 8: Straight Time Hours Saturday_Row 8: Straight Time Hours Friday_row 8: Straight Time Hours Thursday_row 8: Straight Time Hours Wednesday_row 8: Straight Time Hours Tuesday_row 8: Straight Time Hours Monday_row 8: Straight Time Hours Sunday_row 8: OverTime hours Saturday_row 7: OverTime hours Thursday_row 7: OverTime hours Wednesday_Row 7: OverTime hours Tuesday_Row 7: OverTime hours Monday_Row 7: OverTime hours Sunday_Row 8: OverTime hours Sunday_Row 7: Straight Time Hours Saturday_Row 7: Straight Time Hours Friday_row 7: Straight Time Hours Thursday_row 7: Straight Time Hours Wednesday_row 7: Straight Time Hours Tuesday_row 7: Straight Time Hours Monday_row 7: Straight Time Hours Sunday_row 7: OverTime hours Saturday_row 6: OverTime hours Friday_row 6: OverTime hours Thursday_row 6: OverTime hours Wednesday_Row 6: OverTime hours Tuesday_Row 6: OverTime hours Monday_Row 6: Straight Time Hours Saturday_Row 6: Straight Time Hours Friday_row 6: Straight Time Hours Thursday_row 6: Straight Time Hours Wednesday_row 6: Straight Time Hours Tuesday_row 6: Straight Time Hours Monday_row 6: Straight Time Hours Sunday_row 6: Straight Time Hours Sunday_row 5: Straight Time Hours Saturday_Row 5: OverTime hours Saturday_row 5: OverTime hours Friday_row 5: OverTime hours Thursday_row 5: OverTime hours Wednesday_Row 5: OverTime hours Tuesday_Row 5: OverTime hours Monday_Row 5: OverTime hours Sunday_Row 6: OverTime hours Sunday_Row 5: Straight Time Hours Friday_row 5: Straight Time Hours Thursday_row 5: Straight Time Hours Wednesday_row 5: Straight Time Hours Tuesday_row 5: Straight Time Hours Monday_row 5: OverTime hours Saturday_row 4: OverTime hours Thursday_row 4: OverTime hours Wednesday_Row 4: OverTime hours Tuesday_Row 4: OverTime hours Monday_Row 4: OverTime hours Sunday_row 4: Straight Time Hours Saturday_Row 4: Straight Time Hours Friday_row 4: Straight Time Hours Thursday_row 4: Straight Time Hours Wednesday_row 4: Straight Time Hours Tuesday_row 4: Straight Time Hours Monday_row 4: Straight Time hours Sunday_Row 4: Vac_row 4: Vac_row 5: Vac_row 7: Vac_row 8: Vac_row 10: Other_row 4: Other_row 5: Other_row 6: Other_row 7: Other_row 8: Other_row 10: Pen_row 9: Vac_row 9: Vac_row 6: Pen_row 6: Other_row 9: Month and Day_2: Year_2: Month and Day_3: Year_yyyy: Telephone Number: Fax Number: Gross Amount Paid For Week_Row 4: Straight Time hours Sunday row 1: Straight Time hours Sunday row 2: Straight Time hours Sunday row 3: Sun 1: Sun 2: Mon 2: Mon 1: Tues 1: Tues 2: Wed 1: Wed 2: Thurs 2: Thurs 1: Fri 1: Fri 2: Sat 1: Sat 2: Year 1: OverTime hours Friday_row 7: OverTime hours Friday_row 4: