700 010 69 Form PDF Details

The 700 010 69 form, issued by the State of Florida Department of Transportation, serves a pivotal role in ensuring fair wage practices within the framework of construction projects. This comprehensive document, encompassing a statement of compliance, wage and hour record, deductions record, and fringe benefits record, mandates a declaration by signatories that all employees have received their rightfully earned wages, without improper deductions or rebates, during a specified payroll period. It further requires the assurance that payroll submissions are accurate and adhere to the minimum wage rates as per contract stipulations and that any employed apprentices are registered with recognized apprenticeship programs. Moreover, the form details the provision of fringe benefits, whether paid into approved plans or directly in cash, highlighting a commitment to upholding employee rights and labor standards. The responsibility placed on contractors or subcontractors to accurately report hourly wages, deductions, and fringe benefits underscores the form’s critical role in protecting laborers and mechanics from wage theft and promoting transparency. Notably, the document warns that falsification of these statements could lead to civil or criminal prosecution, underscoring the legal seriousness of the form's assertions.

QuestionAnswer
Form Name700 010 69 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesfdot form 275 010 69, 700 69 fdot form, 700 010 fdot form, 700 010 69

Form Preview Example

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

WAGE AND HOUR RECO RD

Statement of Compliance:

700-010-69 Construction 02/11

DATE

I,

 

(Name of signatory party)

 

 

 

(Title)

do hereby state:

 

 

 

 

 

 

 

 

(1) That I pay or supervise the payment of the persons employed by

 

 

 

 

on the

;

(Contractor or Subcontractor)

 

(Building or work)

that during the payroll period commencing on the

 

 

day of

 

and ending the

 

day of

 

 

 

 

all persons employed

on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said

from the full weekly

(Contractor or Subcontractor)

wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended

(48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 3145), and described below:

(c) EXCEPTIONS

EXCEPTION (CRAFT)

EXPLANATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REMARKS:

(2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.

(3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists

in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.

(4)That:

(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.

(b) WHERE FRINGE BENEFITS ARE PAID IN CASH

Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below:

NAME AND TITLE

SIGNATURE

 

 

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 231 OF TITLE 31 OF THE UNITED STATES CODE.

WH-347

Wage and Hour Record:

Contractor's Name

Payroll Number:

(1)

 

Employee Name

 

and 4 Digit Identifier

 

(9 digit SS and full address

(2)

required on contracts Let

Exemptions /

prior to 1/19/09)

Race &

 

 

Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

700-010-69

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Construction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02/11

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contract #

 

 

 

 

 

Project and Location

 

 

 

 

 

 

For Week Ending

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIN #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

Day and Date

 

(6)

 

(7)

 

(8)

Deductions

 

(9)

 

 

(10)

 

 

 

(5)

 

 

 

 

 

 

 

 

Total

Pay Rate

 

Project

 

 

Net Wages

 

Total from

 

 

 

 

 

 

 

 

 

 

Hours

 

 

Gross /

FICA

With-

 

 

 

Total from

Total

Paid for

 

Fringe Benefit

 

 

Time

 

 

 

 

 

 

 

 

 

 

Weekly

 

holding

 

 

 

Deduction

Deductions

 

 

(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

week

 

 

Sheet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Over

 

 

 

 

 

 

 

 

 

 

Gross

 

tax

 

 

 

Sheet

 

 

 

 

(attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Classif-

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(attached)

 

 

 

 

 

 

ication

Stright

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

 

O

 

 

 

 

 

 

 

0.00

0.00

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

0.00

 

 

 

 

 

 

 

 

 

$0.00

$

-

 

 

 

700-010-69 Construction 02/11

Deductions Record:

Contractor's Name

Payroll Number:

Address

For Week Ending

FIN #

Contract #

Project and Location

 

 

Type a Deduction description in each box and then record the amount of that Deduction for each employee (or leave blank).

 

 

 

 

 

 

 

 

 

 

 

 

Employee Name (last, first)

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

 

 

Deductions

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

$0.00

Fringe Benefits Record:

Contractor's Name

Payroll Number:

 

For Week Ending

FIN #

Address

700-010-69 Construction 02/11

Contract #

Project and Location

Type a Fringe Benefit description in each box and then record the amount of that Fringe for each employee (or leave blank).

Employee Name (last, first)

Total

Fringe

Benefit

Amount

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

How to Edit 700 010 69 Form Online for Free

The 700 010 69 form must be completed accurately for each payroll period during an FDOT construction contract. Each employee entry must reflect actual wages paid, with no omissions or adjustments not authorized by law.

Step 1: Enter Project and Period Information

At the top of the form, enter the project name, FDOT contract number, and the start and end dates of the payroll period being reported.

Step 2: List Each Employee

For each worker, enter their full name, work classification (such as laborer, heavy equipment operator, or apprentice), and the number of hours worked each day during the payroll period.

Step 3: Record Wages and Deductions

Enter the hourly pay rate and total gross wages for each employee. List all authorized deductions, including federal and state income taxes. Record the net wages paid to each worker for the period.

Step 4: Complete the Fringe Benefits Section

Indicate fringe benefits provided to each employee, whether paid into an approved benefit plan or delivered directly in cash. Include the per-hour rate and the total amount for the payroll period.

Step 5: Sign the Statement of Compliance

The contractor or an authorized company representative must sign and date the Statement of Compliance at the bottom of the form. This signature certifies that all payroll records are accurate and that minimum wage rates were followed. Falsifying this statement can result in civil or criminal prosecution under Florida and federal law.

Who Needs to Use This Form

The 700 010 69 form applies to all contractors and subcontractors working on FDOT-funded construction projects. It is submitted to the project owner or contract administrator along with the weekly payroll records. Subcontractors must file their own separate submissions for each payroll period.

For payroll compliance on federally funded projects, contractors typically use the certified payroll form (WH-347) instead. Both forms serve the same core purpose: verifying that workers are paid lawful wages. You may also need the construction proposal form when bidding on FDOT contracts.

Frequently Asked Questions

What is the 700 010 69 form used for?

The 700 010 69 form is used by contractors on FDOT construction contracts to report payroll data, certify wage compliance, and document deductions and fringe benefits for each payroll period.

How often is the 700 010 69 form submitted?

The form is submitted once per weekly payroll period throughout the duration of the active construction contract. A separate submission is required for each payroll period.

Is the 700 010 69 form different from WH-347?

Yes. The 700 010 69 is specific to FDOT state contracts, while the WH-347 certified payroll form applies to federally funded projects under the Davis-Bacon Act. Both require similar payroll data but are issued by different agencies.

What happens if the form is filled out incorrectly?

Inaccurate or falsified entries on the 700 010 69 form can lead to contract penalties, disqualification from future FDOT projects, and civil or criminal prosecution. Always verify all figures before signing.