ࡱ> KMJy 'bjbj =:{{L..841$$$$$?1A1A1A1A1A1A1$3T6e1e1$$z1R$$?1?1.0$piQg/+1101/\770070Pe1e117. N: Restitution Requirements for NH DOT Projects The following procedures cover the requirements for restitution of minimum wages payable in accordance with the applicable Davis-Bacon wage determination. These requirements cover all restitution to be paid by a contractor, regardless of the action that prompted it: A fully completed restitution package shall consist of the following three items: An OFC Form 8, Employee Pay Restitution Worksheet Copy of restitution check Signed employee restitution affidavit OFC Form 8, Employee Pay Restitution Worksheet: Companies must ensure the Form 8 is fully completed. A separate worksheet is required for each worker, for each classification of work for each pay period in which an underpayment was made. Copy of restitution check. Companies cannot combine restitution amounts with any other pay received. Restitution amounts must be totally separate from all other pay received (see the one exception below in Additional Notes amounts of $15.00 or less). In addition, pay statement shall clearly indicate the purpose of the check is to provide restitution and will list the project name and number thereon. One single check can be used to provide restitution to multiple pay periods as long as totals indicated on the worksheets equal the check amount. Employee Restitution Affidavit: A signed employee restitution affidavit shall accompany each restitution submission. Completed restitution packages may be emailed to the respective NHDOT Federal Compliance Officer covering the project; faxed to (603) 271-8048, or mailed to: Chief of Labor Compliance NH Department of Transportation P.O. Box 483, 7 Hazen Drive Concord, NH 03302-0483 Additional Notes: IMPORTANT EXCEPTION: In those cases when restitution amounts are $15.00 or less, companies may make restitution in the employees next paycheck if the employee will work on the same project the week immediately following the week in which the underpayment was made. Companies must include a comment on the certified payroll that the restitution was included in the overall weekly gross amount paid to the employee and what the amount was. Include only wages payable under the appropriate work classification. The amount indicated in #11 Total Amount Due Employee is the gross amount due. The amount indicated in the Certification section at the lower portion of the restitution worksheet is the net amount (the amount of the restitution check). We will accept restitution documentation by fax only if the transmitted documents are legible. If you will also be forwarding a copy of documentation by mail, please indicate this on the fax cover sheet. If you are sending the originals by mail only, please ensure your submission arrives on or before the due date. If you have any questions regarding restitution payments, please contact the NH DOT Federal Compliance Officer for your project or the Chief of Labor Compliance at (603) 271-2467. NH DOT Employee Pay Restitution Worksheet 1. Name of Company: ______________________________ Name/Title of Person Completing This Report: ________________________________________________ (Printed Name) (Title) 3. Phone Number: _____________________ Fax: ______________________ 4. Name of Project: ______________________________ Project #: ____________________ 5. Payroll Week Ending: __________________________ 6. How Restitution Originated: ____ NHDOT Audit ____ Self-identified _____USDOL Higher Rate Stipulated 7. Employee: ______________________________ ________________________________ Name Work Classification 8. Total Hours Worked: S/T: _______________________ O/T: _________________________ 9. Original Payment Breakout (amount appearing on payroll the worker was previously paid): a. Straight Time Paid: _________________ @ _____________ = ______________ Number Hours Pay Rate Sub-Total b. Overtime Paid: _________________ @ _____________ = ______________ Number Hours Pay Rate Sub-Total 10. Revised/Corrected Payment Breakout (show the amount the worker should have been paid): a. Straight Time Paid: _________________ @ _____________ = ______________ # Hours *Pay Rate Sub-Total b. Overtime Paid: _________________ @ _____________ = ______________ # Hours **Pay Rate Sub-Total 11a. Amount Previously Paid: $ ______________ 11b. Revised Amount: $ ________________ (Gross) (Gross) 12. TOTAL AMOUNT DUE EMPLOYEE (this classification): (11b minus 11a): $ _____________________ (Gross) CERTIFICATION: This is to certify that a check in the amount of $ ________________ (net) was provided to the person identified on line 7 above on ___________________. A copy of the restitution check and the signed Employee Restitution Affidavit is attached as proof of restitution. The amount paid includes overtime computed at a rate of one and one half times the base pay rate due the employee according to the Contract & Davis-Bacon Act. I understand that a separate worksheet must be completed on each employee, for each payroll period in question (one restitution check can be used). The total above represents the full amount due the employee. ________________________________ _________________ Signature Date * This amount must, at a minimum, be equal the base rate + fringe rate stated in the Wage Schedule. You may deduct from this amount the hourly fringes paid to the employee by attaching a Fringe Benefit Breakout Report. ** The overtime rate shall be the sum of the base rate, plus half of the base rate, plus the required fringes at the straight time rate: ((Base rate X 1.5) + fringe amount) - (applicable hourly fringes from attached Fringe Benefit Breakout Report)) = minimum overtime rate ______________________________________ Company Name ______________________________________ Street Address ______________________________________ City, State, Zip Code EMPLOYEE RESTITUTION AFFIDAVIT I, _____________________________, have received payment in the amount of _____________. I understand that this amount represents the difference between previous wages paid by my employer and those required by the Federal Wage Decision made part of the contract and posted at the site of work. This amount represents restitution for weekly pay period(s) ending: _____________________________ and are applicable to the following project: Project Name & Number: ____________________________________ _____________________________ Employee Signature ____________________________________________ Employee Printed Name ________________________ Date ____________________________________ ___________________________________________ Witness Printed Name Witness Signature ____________________________________ Date     OFC Form 8 (REV: 1/10/2014) Previous editions cannot be used -:  / $ B 46OR6=^vxy𻯤xphh`hRCJaJh CJaJhibCJaJh7CJaJh`hRCJaJh^5>*CJaJh`hR5>*CJaJh`h`CJaJh^h`5CJaJh^hib5CJaJ hTwCJ h7CJ hJCJ h^CJ h`>*CJh`5>*CJ\ h`CJ hRCJhR#-.; <  # $ ;<Vv ]^gd $h^ha$gdUe$h^ha$h^h & F & Fyz  \$ & Fa$$a$ & F ]^gd ]^gd  & F ]^gd ]^gd`yz<W_mn)/b6CP x!""""""""ýɷɭɷɷɷɧ~x~ hRCJhR h X'CJhR5B*CJ\aJphhRB*CJOJQJaJph hRCJhR5>*CJ\ h X'CJ h !dCJ hUeCJ hRCJhR5CJ\ hR>*CJ hR>* hRCJh`h`CJaJh`h`CJaJ/89st,78{|?4  C x `  p]pgd !d45)*56. x!"""""""""$a$$ a$[$\$^    x ` [ `""""#8#9#:#;#Z#[#\#]#%%R%S%T%U%s%%%%%%%%%%%$a$"""#8#\#]#s%%%&&&&&&&&&&&&&&&'''¾h !d h !dCJ h !dCJh !dB*CJaJphh $jh $U hRCJ hRH* hR>*hR hRCJ%%P&&&&&&&&&&&&&&&&&&&&&'''h^h; 0PP&P1h/ =!"#@$`% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH H`H Normal@CJ]_HaJmH sH tH D@D  Heading 1$$@&a$ >*@]DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List 6>@6 Title$a$ 5CJ \44 Header  !4 @4 Footer  !LC@"L Body Text Indent h^h@]Z^@2Z  Normal (Web)dd[$\$@CJOJQJ]aJ.)A.  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