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What a finished one looks like

WH-347 certified payroll, week ending 09/13/2026, names redactedU.S. Department of Labor · Wage and Hour DivisionPayrollFor Contractor or Subcontractor's Optional Use; See Instructions, Form WH-347 Inst.WH-347OMB No. 1235-0008 · Expires 04/30/2027Name of contractoror subcontractorAddressPayroll no.14For week ending09/13/2026Project and locationProject or contract no.Name and individualidentifying number(last 4 of SSN)No. ofW/Hexempt.WorkclassificationDayS 9/7DayM 9/8DayT 9/9DayW 9/10DayT 9/11DayF 9/12DayS 9/13TotalhoursRateof payGrossamountearnedFICAWith-holdingtaxOtherTotaldeduct.Net wagespaid forweek2Carpenter888884060.102,404.00183.91288.480.00472.391,931.611Laborer888884045.301,812.00138.62217.440.00356.061,455.940Carpenter appr., 2nd yr888884033.061,322.40101.16158.690.00259.851,062.553Mason888884063.852,554.00195.38306.480.00501.862,052.141Laborer888483645.301,630.80124.76195.700.00320.461,310.342Operating engineer88883272.402,316.80177.24278.020.00455.261,861.541Carpenter888884060.102,404.00183.91288.480.00472.391,931.610Laborer888884045.301,812.00138.62217.440.00356.061,455.94Hours worked each day: straight time. Overtime is listed on a separate line and paid at 1.5x the basic hourly rate.Fringe benefits paid to approved plans, funds or programs per the wage determination; see Statement of Compliance, page 2, item 4(a).Statement of ComplianceI, the undersigned, do hereby state that I pay or supervise the payment of the persons employed by the contractor on the above project;that during the payroll period commencing 09/07/2026 and ending 09/13/2026 all persons employed on said project have been paid the fullweekly wages earned, that no rebates have been or will be made, and that the wage rates are not less than those in the applicable schedule.Name and titleSignatureDate09/17/2026Willful falsification may subject the contractor to civil or criminal prosecution. See section 1001 of title 18 and section 231 of title 31 of the United States Code.Prepared by The Office Arm · Reviewed 09/16/2026 · Page 1 of 2
WH-347, Week ending 09/13/2026
AIA G703 continuation sheet, application no. 4, project and contractor redactedAIA Document G703 · Continuation sheetContinuation SheetAIA Document G702, Application and Certificate for Payment, containing Contractor's signed certification, is attached.Application no.04Application date 09/01/2026 · Period to 08/31/2026Architect's project no.ProjectContractorIn tabulations below, amounts are stated in US dollars. Column I is used because a variable retainage rate applies to stored materials.AItemno.BDescription of workCScheduledvalueDFrom previousapplicationEThis periodFMaterialsstoredGTotal completedand stored%(G ÷ C)HBalance tofinish (C – G)IRetainage(5%)01General conditions48,000.0028,800.004,800.000.0033,600.007014,400.001,680.0002Demolition32,500.0032,500.000.000.0032,500.001000.001,625.0003Concrete86,000.0073,100.008,600.000.0081,700.00954,300.004,085.0004Masonry124,000.0062,000.0024,800.000.0086,800.007037,200.004,340.0005Rough carpentry68,000.0020,400.0017,000.000.0037,400.005530,600.001,870.0006Roofing41,000.000.000.000.000.00041,000.000.0007Windows and storefront57,500.000.000.0012,000.0012,000.002145,500.00600.0008Drywall and ceilings72,000.000.000.000.000.00072,000.000.0009Painting24,500.000.000.000.000.00024,500.000.0010Plumbing96,000.0024,000.0014,400.000.0038,400.004057,600.001,920.0011Electrical88,000.0017,600.0013,200.000.0030,800.003557,200.001,540.0012HVAC112,000.0016,800.0011,200.000.0028,000.002584,000.001,400.0013CO 01: added scope, 2nd fl. pantry12,300.000.006,150.000.006,150.00506,150.00307.50Grand total861,800.00275,200.00100,150.0012,000.00387,350.0045474,450.0019,367.50Retainage at 5% per the contract · Stored materials supported by invoices and bills of sale, attachedPrepared by The Office Arm · Reviewed 08/30/2026 · Page 2 of 2
G703, App. No. 04, 09/01/2026