251-26 Cert Pay 3 - 6.26.26_Redacted.pdf

SUBMIT form by email: equalpayact@dol.nj.gov IMPORTANT: For purposes of law, you must also submit this form to the appropriate public body or lessor. Payroll Certification for Public Works Projects for Contractor and Subcontractor’s Weekly and Final Certification Name of  Contractor or  Subcontractor F.E.I.N. Business Address Project Location Payroll No. Week Ending Date or  Final Certification NJ Department of Labor & Workforce Development Project Name Contract I.D. or Project I.D. Contractor Registration #Date Wages Due & Paid (mm/dd/yyyy) W= White; B= Black or African American; A= Asian; N= American Indian or Native Alaskan; I = Native Hawaiian or Pacific Islander; M= 2 or More MW-562 (9/19)  Check if additional sheets used 1. 5. 6. 9. 10. Job Title Sex Race SU MO TU WE TH FR SA Hourly M=Male F=Female and Address journeyman, foreman e.g., carpenter, mason, plumber X=Non-Binary Hours of Pay Project Week FICA O O S S O O S S O O S S O O S S S O 2. Work Hours worked each day DeductionsGross Amt. Earned Straight Time or Overtime 3. Demographics 7. 8.4. Day and Date mm/dd mm/dd mm/dd mm/dd mm/dd mm/ddEmployee Name mm/dd Total Deductions Net Wages Paid for Week Total Fringe Benefit Cost/Hour e.g., apprentice, Work Classification/ Occupational Category See Key Federal Tax Total Rate This This State Tax Other (specify) Other (specify)