Certified Payroll Form

I pay or supervise the payment of the persons employed by I CONTRACTOR SUBCONTRACTOR OR SURETY that during the payroll period BUILDING OR WORK day of and ending the day commencing on the MONTH YEAR all persons employed on said project have been paid the of full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as specified in ORS 652. 845 SUBCONTRACTOR PAYROLL NO. Business Name DBA Phone Project Name Street Address Type of Work Project Location Project County Date Pay Period Began THIS SECTION FOR PRIME CONTRACTORS ONLY Public Contracting Agency Name Date Contract Specifications First Advertised for Bid Contract Amount NAME ADDRESS AND EMPLOYEE S IDENTIFICATION NUMBER CCB Registration Number Mailing Address 3 DAY AND DATE.
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