CDOT Form 118 "Contractor Wage Compliance Statement" - Colorado

What Is CDOT Form 118?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 118 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download CDOT Form 118 "Contractor Wage Compliance Statement" - Colorado

1076 times
Rate (4.3 / 5) 64 votes
Project Code:
Colorado Department of Transportation
CONTRACTOR WAGE COMPLIANCE STATEMENT
Project Number:
Project Location:
Contractors/subcontractors
Completion of the payroll supervisor appointment and perjury statement is required by the U.S. Department of
Labor and is included on the back of this form. Contractors/subcontractors are required to pay weekly; complete both
sides of this form in full and attach to each payroll for the seven day payroll period. Prime contractors are required to
submit the forms within seven days of the weekly payroll period to the project engineer; subcontractors submit forms for
review to the prime contractor prior to submission to CDOT. The prime contractor is responsible for subcontractor payroll
submittal and compliance; by submittal of subcontractor payrolls, the prime contractor certifies that they have reviewed the
submittal for compliance.
Contractor/subcontractor name
Payroll number
Payroll period
to
Fringe benefit information:
Name(s)/addresses of fringe benefit administrator(s):
Contact person and phone number(s):
Contributions are made in cash or to the plans, funds or programs described below at least quarterly. There are no past
due deposits. List the value of the fringe amount as the dollar amount per hour. Documentation of calculations used to
determine hourly rates shall be available upon request. Please attach additional information as necessary if fringe
contributions vary by employee.
cash
______
pension
_______
health insurance
______
vacation
_______
dental insurance
______
holiday
_______
life insurance
______
other (describe) _______
All on-the-job trainees (OJTs) employed in the above period are registered in and paid according to a bona fide training
program approved by the Colorado Department of Transportation and the Federal Highway Administration. Each trainee has
also been approved for work on this contract.
I declare under penalty of perjury in the second degree, and any other State or Federal laws that the statements made in
this document are true and complete to the best of my knowledge.
Contractor/subcontractor payroll supervisor or signatory party
Date
10/16
Previous editions are obsolete and may not be used
Page 1 of 2 (over)
CDOT Form #118
Project Code:
Colorado Department of Transportation
CONTRACTOR WAGE COMPLIANCE STATEMENT
Project Number:
Project Location:
Contractors/subcontractors
Completion of the payroll supervisor appointment and perjury statement is required by the U.S. Department of
Labor and is included on the back of this form. Contractors/subcontractors are required to pay weekly; complete both
sides of this form in full and attach to each payroll for the seven day payroll period. Prime contractors are required to
submit the forms within seven days of the weekly payroll period to the project engineer; subcontractors submit forms for
review to the prime contractor prior to submission to CDOT. The prime contractor is responsible for subcontractor payroll
submittal and compliance; by submittal of subcontractor payrolls, the prime contractor certifies that they have reviewed the
submittal for compliance.
Contractor/subcontractor name
Payroll number
Payroll period
to
Fringe benefit information:
Name(s)/addresses of fringe benefit administrator(s):
Contact person and phone number(s):
Contributions are made in cash or to the plans, funds or programs described below at least quarterly. There are no past
due deposits. List the value of the fringe amount as the dollar amount per hour. Documentation of calculations used to
determine hourly rates shall be available upon request. Please attach additional information as necessary if fringe
contributions vary by employee.
cash
______
pension
_______
health insurance
______
vacation
_______
dental insurance
______
holiday
_______
life insurance
______
other (describe) _______
All on-the-job trainees (OJTs) employed in the above period are registered in and paid according to a bona fide training
program approved by the Colorado Department of Transportation and the Federal Highway Administration. Each trainee has
also been approved for work on this contract.
I declare under penalty of perjury in the second degree, and any other State or Federal laws that the statements made in
this document are true and complete to the best of my knowledge.
Contractor/subcontractor payroll supervisor or signatory party
Date
10/16
Previous editions are obsolete and may not be used
Page 1 of 2 (over)
CDOT Form #118
Date
(Title)
(Name of signatory party)
do hereby state:
I,
(1) That I pay or supervise the payment of the persons employed by
(Building or work)
(Contractor or Subcontractor)
on the
;
that during the payroll period commencing on the
Month
Month
day of
Year
day of
Year
and ending the
all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be
made either directly or indirectly to or on behalf of said
(Contractor or Subcontractor)
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 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.
967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
(2) That any payrolls 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 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 recognized by the Bureau of Apprenticeship and Training, United States Department
of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and
Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGES BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,
payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the
benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGES BENEFITS ARE PAID IN CASH
Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, 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
Exception (craft)
Explanation
Remarks
Name and Title
Signature
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR
TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES
CODE.
10/16
Previous editions are obsolete and may not be used
Page 2 of 2
CDOT Form #118
Page of 2