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<br />EXHIBIT VIII-S
<br />SAMPLE CONTRACTOR I SUBCONTRACTOR PAYROLL, Form WH-347
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<br />"1'MEO~CONTRACTO~" ,,', " , . OR SUBCONTRACTOR < '",> .' '", ADDRESS . ' , . ,,', '.'.' ">'
<br />~AYRQLLN().T, "i:<,: '. ',',' "',', FOR we"EK ~,DiNii ",',',;';:;":' '" ',' PROJECT & lOCATION , PROJECT OR CONTRACT NO. , ,;;.",'"i,),
<br /> .
<br />NAME, ADDRESS, & SOCIAL NO WORKER DAY OF \^lEEK GROSS DEDUCTIONS NET
<br />SECURITY NUMBER WIHOlD CLASS TOTAL RATE AMOUNT WAGES
<br /> & S M T W T F S HOURS OF PAY EARNED FICA WITHHOLD- Slate V" OTHER TOTAL PAID FOR
<br /> EXEMPT ING TAX Wlhold Fund DEDUCTION WEEK
<br /> a 9 10 11 12 13 14 S
<br /> HOURS WORKED EACH DAY
<br />John Doe 521-44-7086 1 Foreman" OT 2 2 1 1 6 $10.95
<br />1974 Clark Avenue Carpenter $357.70 $1518 $53.60 $8.00 $1000 $86.78 $270.92
<br />Downtown, CO 80311 ST a a a a a 40 $7.30
<br />Dick Brown 544-44-7086 2 3cu. Yd. OT Insurance
<br />P,D Box 245 Backhoe Oper. I I $6500 $175.00
<br />Anvtown. CO 80202 ST a a a a a 40 $fi nn ';2.:1000 ~10.00 S~5,QO $500 $5.CO
<br />John Dca 141 "55-7805 0 10cu_ Yd OT
<br />16555thAvenue Truck Driver
<br /> , , , , ,- I' , , , 1$116.10 , , , I i , , "
<br />II ~ , __ u_u_ ST 4 0 18" $6.45 $559 $22_00 $700 1$3459 $81,51
<br />I ~omewnere, l.-U l:IULU.:l
<br /> 2 Cement Mason I ! I I I I
<br />II Joho Joo",oo 505-43,547' OT Luu
<br />515 Broadway I
<br /> 10 I
<br />'" ,.....,,"'..... S T 0 0 0 , -- ---- , ... ... ... no ... ... "
<br />II ""ra.,vv..",.... I , , , 1- ,- ,- I ,- , " 1:b::'",U I :bltlUUU I I ,
<br /> I I I , I I I
<br />I , , , , ,
<br />Bill Thomas 515-38-1005 2 Cemeni Mason aT
<br />1050 Clearbndge Junction
<br />Why Here, CO 88888 ST 8 8 a a 32 $656 $20992 .... .... .... .... .... ....
<br />Tom Thompson 505--43-5478 I 0 Cement Mason OT I I I I I I I I
<br />P,O, Box 1111 -.- I I
<br />Urbania, CO 88008 ST 4 7 a 19 $5,90 $112_10
<br />Tom Thompson 505-43.5478 . Latlorar-" or ! I I 1$4250 I $17355 I
<br />PO Box 1111 $10395
<br />Urbania, CO 88008 ST 4 1 a a 21 $495 $21605 $1080 $1590 5580 $1000
<br />Harry James 555-12-1212 (Owner) OT
<br />Bebop Street Tile Seiter
<br />II Jazzville, CO 80202
<br />. A working foreman 15 one who, in addition to hlslher supervisory dulies, alleas! 20% performs the work of a laborer or mechanic dunng a substantial part of hislher work week
<br />*" Employee working on more than one job- detail ONLY the hours on thiS Job
<br />~ Fringe benefits paid into an approved fund or plan -- Fnnge benefits paid in cash
<br />-.- Employee working two classifications during the work week. -Work,ngowner.
<br /> \1111 c t::: (Rellor;ad f'ii;l>ll
<br /> ".,,-...-.....
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