Public Works Fringe Benefit Statement

Prevailing Wage Document: Public Works Fringe Benefit Statement
Frequency of Submitting Form: One-Time Submittal*
Updated: May 31, 2016


All contractors must complete the Public Works Fringe Benefit Statement (“FBS”) for all journeyman and apprentice trades their company dispatches on a public works project. This form is used to list the various trust funds where Union (and non-union) contractors send their required fringe benefit payments each month.


  1. CLASSIFICATION – The fringe benefit statement must include all Trades / Classifications of employees from contractor that will be working on the job.
  2. EFFECTIVE DATE – Date of the DIR Prevailing Wage Determination governing the duration of the Public Works Project.
  3. SUBSISTENCE OR TRAVEL – Only applies if contractor is required to pay this fringe benefit. If so, insert per diem amount.
  4. EMPLOYER PAID FRINGE BENEFITS – Next to each listed fringe benefit, note the hourly rates for fringe benefit payments made for employees, by the employer on the assortment of work classes. Amounts paid directly to the employee are not to be included.
  5. PAID TO – Insert the name and address of the fund where the benefit will be sent, or if the benefit amount is to be paid directly to the employee, indicate by noting as “EMPLOYEE”

Other Helpful Information

Fringe benefit statements need to show the dollar rate of each fringe on the form. If there are various rates for a particular fringe, each rate needs to be shown and not noted as “various” in the rate section. The fringe benefit statement is to assist in efforts of auditing reports to ensure fully loaded rates are being paid correctly and appropriately.

Web link to form:

Consisted Of

Fringe benefits are typically, but not limited: to health and welfare, pension, vacation and training 1 . Non-union contractors will typically pay the fringe benefits to either the company’s “like kind” programs for each fringe or directly to the worker as part of their hourly wage. Non-union contractors must also indicate “NON-UNION” on the Fringe Benefit Statement when submitting their forms to simplify this process.

These forms are submitted when any of the following occur (*):

  • With The First Certified Payroll
  • Wage Rates Are Updated
  • When There Is A Change In Fringe Benefits