Guidance for preparing an



Davis-Bacon and Related Acts Payroll Certification

NOTE: This certification is required for all projects receiving funding from DWRLF that must comply with Davis-Bacon requirements as indicated in the loan closing documents. All Payment Requests seeking reimbursement for construction costs must include this certification.

Name of Water System: _______________________________________________________

Name of Project: ______________________________ DWRLF Project No. ____________

Contractor / Subcontractor: __________________________________________________

Weekly Payroll Numbers and Dates Covered by this Certification:

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Payroll No.: ______ From: ____________ To: ____________ Comments: ________________

Interview Verifications:

Recipients must conduct a minimum of two interviews: the first within two weeks of initial payroll submission, and the second two weeks prior to the completion date of the contract or sub-contract. Additional interviews should be performed if problems are found during the initial interview and at other times when needed. An interview form (Standard Form 1445 or equivalent) must be completed with every interview and kept on file.

Initial Interview Date: _____________ Interview Date: _____________ Interview Date: _____________

Interview Date: _____________ Interview Date: _____________ Final Interview Date: _____________

|CERTIFICATION |

I certify to the best of my knowledge and belief that the above referenced project complies with the Davis-Bacon and Related Acts requirements as indicated in the loan closing documents and that all laborers and mechanics employed by contractors and subcontractors during the above referenced period were paid wages at rates not less than those listed on the prevailing wage rate contained in the contract documents and that all applicable provisions of the Davis-Bacon and Related Acts have been met.

|Name of Certifying Official: |Title of Person Certifying: |

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|Signature: |Phone Number: |Date Signed: |

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Payrolls and basic records must be maintained by the contractor for three years from project completion.

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