IMCO General Construction, Inc. 6/10/2024

1. Name and residence address of each worker. 2. Classification of work performed by each worker. The classification must be specific and match the classification categories listed in the applicable wage schedule. 3. Total number of hours employed each day. 4. Total number of hours employed during the payroll period. 5. Straight time and overtime hourly rate of wages paid to each worker. 6. Total or gross amount earned by each worker. 7. Deductions for medical insurance, FICA, federal withholding tax, and any other deductions taken. 8. Net amount paid each worker. 9. Contractor's or subcontractor's name and address. 10. All days during the pay period. 11. Date of final day of pay period. 12. Whether fringe benefits were paid to each worker as part of the hourly wage rate or whether fringe benefits were paid into an approved plan, fund, or program; and the hourly rate of fringe benefits paid, if any. For federally -funded projects, payroll reports may be submitted on federal payroll form WH 347 or equivalent, which may be obtained by accessing their website: https://www.dol.gov/agencies/whd/government- contracts/construction/payrollcertification. The reverse side of the form contains an affidavit that must be filled out and signed. 13. If the Contractor's payroll reports are computerized, the computerized reports may be submitted along with a Statement of Compliance Affidavit form a copy of which can be obtained from the City. The first payroll submitted for the Work for both the Contractor and each subcontractor must be labeled "Initial". The last payroll submitted for the Work for both the Contractor and each subcontractor must be labeled "Final". If no work is performed for the week, the Contractor must submit a certified payroll noting that no work has been performed. END OF SECTION Reservoir 3 Replacement Phase 1 Work Order No. UP3739 00 73 43 WAGE RATE REQUIREMENT March 2024