Form CEM-4902B "Extra Work Bill - Labor Charges" - California

What Is Form CEM-4902B?

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

Form Details:

  • Released on July 1, 1994;
  • The latest edition provided by the California 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 Form CEM-4902B by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
PAGE
CONTRACT NO.
CCO NO. REPORT NO. LABOR SURCHARGE WCI CLASS
WCI RATE
CEM-4902B (NEW 7/1994) CT# 7541-3497-9
$
of
NAME
REGULAR HOURS
PREMIUM HOURS
SUBSISTENCE
CRAFT ID
INT
LAST
HRS
RATE
HRS
RATE
UNITS
RATE
TOTAL
34
$
$
$
.
.
.
.
.
.
35
$
$
$
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36
$
$
$
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37
$
$
$
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38
$
$
$
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39
$
$
$
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40
$
$
$
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41
$
$
$
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42
$
$
$
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43
$
$
$
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44
$
$
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45
$
$
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46
$
$
$
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47
$
$
$
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48
$
$
$
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49
$
$
$
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50
$
$
$
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51
$
$
$
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52
$
$
$
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53
$
$
$
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.
TOTAL (C)
TOTAL (D)
TOTAL (E)
$0.00
$0.00
$0.00
OTHER EXPENSES SUBJECT TO LABOR MARKUP
DESCRIPTION
AMOUNT
54
$
.
TRAVEL EXPENSE
EXTENDED TOTAL (F)
UNITS
RATE
$
.
.
SIGNATURE (Resident Engineer)
IN CASE OF QUESTION:
(Resident Engineer Use Only)
SIGNATURE (Prime Contractor's Representative)
NAME
BUSINESS PHONE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
PAGE
CONTRACT NO.
CCO NO. REPORT NO. LABOR SURCHARGE WCI CLASS
WCI RATE
CEM-4902B (NEW 7/1994) CT# 7541-3497-9
$
of
NAME
REGULAR HOURS
PREMIUM HOURS
SUBSISTENCE
CRAFT ID
INT
LAST
HRS
RATE
HRS
RATE
UNITS
RATE
TOTAL
34
$
$
$
.
.
.
.
.
.
35
$
$
$
.
.
.
.
.
.
36
$
$
$
.
.
.
.
.
.
37
$
$
$
.
.
.
.
.
.
38
$
$
$
.
.
.
.
.
.
39
$
$
$
.
.
.
.
.
.
40
$
$
$
.
.
.
.
.
.
41
$
$
$
.
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.
42
$
$
$
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.
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.
43
$
$
$
.
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.
44
$
$
$
.
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.
.
.
.
45
$
$
$
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.
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.
46
$
$
$
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.
47
$
$
$
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.
48
$
$
$
.
.
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.
.
.
49
$
$
$
.
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.
.
.
.
50
$
$
$
.
.
.
.
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.
51
$
$
$
.
.
.
.
.
.
52
$
$
$
.
.
.
.
.
.
53
$
$
$
.
.
.
.
.
.
TOTAL (C)
TOTAL (D)
TOTAL (E)
$0.00
$0.00
$0.00
OTHER EXPENSES SUBJECT TO LABOR MARKUP
DESCRIPTION
AMOUNT
54
$
.
TRAVEL EXPENSE
EXTENDED TOTAL (F)
UNITS
RATE
$
.
.
SIGNATURE (Resident Engineer)
IN CASE OF QUESTION:
(Resident Engineer Use Only)
SIGNATURE (Prime Contractor's Representative)
NAME
BUSINESS PHONE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
ADA Notice
CEM-4902B (NEW 7/1994) CT# 7541-3497-9
For individuals with sensory disabilities, this document is available in alternate
formats.
For information call (916) 654-6410 or TDD (916) 654-3880 or write
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Preparing Form CEM 4902B
Form CEM 4902B is provided for entry of the contractor labor costs used to perform work on a contract change order. Information in the shaded area will
not become part of the electronic copy of the bill. The top of this form includes fields that are used to record or calculate labor surcharges. Following is a
list of these fields:
FIELD
REMARKS
Contract Number
Required entry, same as on the Title Page
CCO Number
Required entry, same as on the Title Page
Report Number
Required entry, same as on the Title Page
Labor Surcharge
Enter Surcharge percent as a whole number. Use Surcharge rate that was in effect when the work was done. This
percent surcharge will apply to all labor lines on this Bill.
WCI Class
Optional entry. Choose one of the WCI Classes G01, S01-S09, or D01
WCI Rate
Enter WCI rate if the WCI Class is entered. This rate will apply to all labor lines on this Bill and must be substantiated by
the Contractor.
Craft ID
Required entry.
Name - Initial
Required entry.
Name - Last
Required entry.
Regular Hours - Hours
Enter number of regular hours worked.
Regular Hours - Rate
Enter the regular rate.
Premium Hours - Hours
Enter number of Premium hours worked.
Premium Hours - Rate
Enter the Premium rate.
Subsistence - Units
Enter the Units if subsistence was paid.
Subsistence - Rate
Enter the Rate if subsistence was paid.
Other - Description & Amount
Optional entry for expenses not included in equipment, labor or invoices.
Travel Expenses - Units & Rate
Optional entry when travel expense was required.
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