Davis-Bacon and Related Acts Weekly Certified Payroll Form
U.S. Department of Labor · Wage and Hour Division · Form WH-347 (Rev. January 2025)
OMB No. 1235-0008 · Expires 01/31/2028
☒ Prime Contractor
Project Name
Albany County Courthouse Renovation
Project / Contract No.
ALB-2026-PW-204
Business Name
Summit Civil Constructors, Inc.
Project Location
Albany, Albany, NY
Wage Determination No.
PRC-2026012345
Week Ending Date
2026-06-06
Business Address
1450 Industrial Pkwy Sacramento, CA, 95814
| (1A) Entry | (1B) Last | (1C) First | (1D) MI | (1E) ID No. | (2) J / RA | (3) Classification | S5/31 | M6/1 | T6/2 | W6/3 | T6/4 | F6/5 | S6/6 | (5) Total | (6A) Rate | (6B) Fringe | (6C) In-lieu | (7A) Gross proj | (7B) Gross all | (8) Tax WH | FICA | Other | Total Ded. | (9) Net |
|---|
| 1 | Russo | Frank | | XXX-XX-4417 | J | Journeyman | | 8 | 8 | 8 | 8 | 8 | | 40 | 48.5072.75 | 29.25 | | 1940.00 | 1940.00 | 291.00 | 148.41 | 21.34 | 460.75 | 1479.25 |
| 2 | Park | Denise | | XXX-XX-9920 | J | Building | | 8 | 8 | 8 | 8 | 8 | | 40 | 36.0054.00 | 18.25 | | 1440.00 | 1440.00 | 216.00 | 110.16 | 15.84 | 342.00 | 1098.00 |
Form WH-347 (Rev. January 2025, OMB No. 1235-0008, Expires 01/31/2028). Hours show straight time over overtime. Rate column shows the basic cash rate over the OT rate. Worker identifying number shows the last four SSN digits only.
STATEMENT OF COMPLIANCE
Week Ending Date
2026-06-06
I paid or supervised the payment of the laborers or mechanics working on the above project during the stated time period. I certify the following:
☐The payroll information submitted with this statement is correct and complete for the above project during the above period, and the wage and fringe benefit rates paid to the workers, including credit taken for the reasonably anticipated costs of a bona fide fringe benefit plan, fund or program, are not less than the applicable wage and fringe benefit rates for the classification(s) of work actually performed, as specified in the wage determination(s) incorporated into the contract.
☐All regular payrolls and all other basic records that the contractor is required to maintain for this payroll period are complete and accurate and will be made available upon request from the agency or the Department of Labor.
☐The classifications reported for each laborer or mechanic are the classification(s) of work that each worker actually performed.
☐Any workers paid as apprentices during the above period are duly registered in a bona fide apprenticeship program registered with the Office of Apprenticeship (OA) or a State Apprenticeship Agency (SAA) recognized by the Department of Labor.
☐Fringe benefits have been paid in cash and/or to bona fide fringe benefit plans, funds, or programs, with any hourly credit claimed shown for each worker below.
Hourly Credit for Fringe Benefits
Hourly credit claimed under each bona fide plan for each worker (all plans funded).
| Worker | Zenith H&W TrustHealth/Welfare · H&W-501 · Funded | Laborers PensionPension (DB) · PEN-001 · Funded | Vac/Holiday TrustVacation/Holiday · VH-014 · Funded | JATC Training Tr.Apprent./Training · TRN-301 · Funded | Total |
|---|
| Frank Russo | $11.00 | $14.00 | $3.00 | $1.25 | $29.25 |
| Denise Park | $9.50 | $8.00 | — | $0.75 | $18.25 |
Signature of Certifying Official
DRAFT — not yet certified
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 3729 OF TITLE 31 OF THE UNITED STATES CODE), AS WELL AS DEBARMENT FROM FUTURE FEDERAL AND FEDERALLY-ASSISTED CONTRACTS.