PROJECT NAME                                                                                                                                   PROJECT NO.
CONTRACTOR                                                                                                                                    CONTRACT NO.
SUBCONTRACTOR                                                                                                                                         DATE
                                                                          HOURLY LABOR RATE WORKSHEET
                       TRADE:                                                                              CLASSIFICATION:
                                                                            Rate                         Prevailing Wage Rate
                             Item                                          Per $100       Regular Time         Overtime         Double Time                    Notes
Base Labor Rate
                                           Benefit            Benefit
                                              Paid           Provided
Fringe Benefits:                             (put X in appropriate box)
 Pension 1
 Health/Welfare 1
 Training/Certification 1
 Vacation/Holiday 1
 Other
 Fringe Benefits Subtotal
Total Hourly Rate
Benefits Paid
Total Paid Hourly Rate
Burden: Taxes & Insurance 2
 Other 1
 Other 1
 Burden Subtotal
Contractor Liability Insurance
Small Tools
Other (warranty, record drawings,
payment bonds, performance bonds, etc.)
TOTAL HOURLY RATE (Total Hourly Rate + Burden)                                                                                                 = Amount Contractor paid to employee
                                    Rates certified by:                                                   Company Name:
                                                                           (print name)
                                            Signature:
                                                                                                                                                                    Construction Mgmt.
                                                                                                                                                                     703.33 - 04/12