"Certified Payroll Form" - Connecticut

Certified Payroll Form is a legal document that was released by the Connecticut Department of Transportation - a government authority operating within Connecticut.

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Certification
COMPANY NAME:
PROJ. DESCRIPTION:
PROJECT NUMBER:
The listed hourly rates are the actual hourly rates paid to the following individuals to be
utilized on the subject project as of
and will not be revised prior to
or during negotiations.
ACTUAL
PERMANENT
ACTUAL
AVERAGE**
HOURLY
EMPLOYEE*
EMPLOYEE
CLASSIFICATION
RATE
HRLY.RATE
YES/NO
NAME
certify that the above actual hourly rates are correct and
I,
other factual unit costs supporting the compensation contained within the submitted fee proposal are
accurate, complete and current. I further agree that the proposed agreement shall contain a provision that
the original contract price and any additions thereto shall be adjusted to exclude any significant sums by
which the Commissioner determines the contract price was increased due to inaccurate, incomplete or
noncurrent wage rates and other factual unit costs. All such contract adjustments shall be made during the
life of the contract or within one year following the end of the contract.
* A permanent employee is defined as receiving paid leave and all other company benefits.
** Office average of actual hourly rates of all individuals per classifications.
signature
date
Certification
COMPANY NAME:
PROJ. DESCRIPTION:
PROJECT NUMBER:
The listed hourly rates are the actual hourly rates paid to the following individuals to be
utilized on the subject project as of
and will not be revised prior to
or during negotiations.
ACTUAL
PERMANENT
ACTUAL
AVERAGE**
HOURLY
EMPLOYEE*
EMPLOYEE
CLASSIFICATION
RATE
HRLY.RATE
YES/NO
NAME
certify that the above actual hourly rates are correct and
I,
other factual unit costs supporting the compensation contained within the submitted fee proposal are
accurate, complete and current. I further agree that the proposed agreement shall contain a provision that
the original contract price and any additions thereto shall be adjusted to exclude any significant sums by
which the Commissioner determines the contract price was increased due to inaccurate, incomplete or
noncurrent wage rates and other factual unit costs. All such contract adjustments shall be made during the
life of the contract or within one year following the end of the contract.
* A permanent employee is defined as receiving paid leave and all other company benefits.
** Office average of actual hourly rates of all individuals per classifications.
signature
date