Form CEM-2501 at a glance
What it is: This is the State of California Department of Transportation Fringe Benefit Statement, DOT CEM-2501 (REV 01/2026).
Where and when to file: Complete and submit this form with the first certified payroll. When there have been changes, complete and submit this form.
A filled-in Form CEM-2501 example: a subcontractor lists one classification
How to fill out Form CEM-2501, box by box
Date, Contract Number and Contractor or Subcontractor
Enter the Date, the Contract Number and the Contractor or Subcontractor (Please Print).
Federal-Aid Project Number and license numbers
Enter the Federal-Aid Project Number, the Contractors State License Board Number and the Department of Industrial Registration Number.
Business Address and the Resident Engineer or District Labor Compliance Officer
Enter the Business Address and the Resident Engineer or District Labor Compliance Officer the form is addressed to.
Classification, Effective Date and Fringe Benefit Hourly Amount
Enter the Classification, its Effective Date and Subsistence, Travel Pay, or Both.
Under Fringe Benefit Hourly Amount, enter the Vacation amount and the Health and Welfare amount.
Under Fringe Benefit Hourly Amount, enter Pension, Apprentice or Training Fees and Other.
Enter the Name and Address of Plan, Fund, or Program.
Certification and signature
By signing you certify under penalty of perjury that fringe benefits are paid to the approved Plans, Funds, or Programs listed on this form.
By providing your electronic signature you agree to conduct business transactions by electronic means and that your electronic signature is the legal binding equivalent to your handwritten signature.
Enter the Print Name, the Job Title and the Business Telephone Number, and sign in Signature.
More rules for Form CEM-2501
Labor Compliance uses the following fringe benefits information (shown or referenced on wage rate determinations) paid to or on behalf of employees in various crafts or classifications to check payroll or apply to force account work on the contract listed on this form.
If you have questions about this form, refer to the District and Region map at http://www.dot.ca.gov/hq/construc/LaborCompliance/ for contact information in the district where the project is located.
Sources
[1] Form CEM-2501 (REV 01/2026), Fringe Benefit Statement, California Department of Transportation (the Official source link on this page).