MONTHLY REPORT OF CONTRIBUTIONS
PLUMBERS AND STEAMFITTERS LOCAL 106
Health & Welfare Fund
Pension Trust Fund
Educational & Training Fund
Page 1

Firm Name
Address
Report Covering Period:        From:        To:
Employer's Name
Job / % Appr.
Social Security Number
Hours By Week
Hours Total
1st 2nd 3rd 4th 5th
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total Hours Worked     0


Please Initial Here X_______
MONTHLY REPORT OF CONTRIBUTIONS
PLUMBERS AND STEAMFITTERS LOCAL 106
Health & Welfare Fund
Pension Trust Fund
Educational & Training Fund
Page 2
 
Contributions to working dues check off fund at 4% gross wages.     
Attach separate check made payable to joint plumbers & steamfitters working dues check off fund along with yellow copy of form and mail to 2013 Ryan Street, Lake Charles, Louisiana 70601.
Contributions to health & welfare fund at $4.65 per hour worked.     
Attach separate check made payable to plumbers & steamfitters local 106 health & welfare fund along with original and green copy of form and mail to 822 North Lakeshore drive, Lake Charles, Louisiana 70601.
Contributions to pension trust fund at $3.10 per hour worked.     
Attach separate check made payable to plumbers & steamfitters local 106 pension & trust fund along with original and green copy of form and mail to 822 North Lakeshore drive, Lake Charles, Louisiana 70601.
Contributions to defined contribution fund at $3.99 per hour worked.     
Attach separate check made payable to plumbers & steamfitters local 106 defined contribution fund along with original and green copy of form and mail to 822 North Lakeshore drive, Lake Charles, Louisiana 70601.
Contributions to educational & training fund at .94¢ per hour worked.     
Attach separate check made payable to plumbers & steamfitters local 106 educational & training fund along with pink copy of form and mail to PO Box 1356, Lake Charles, Louisiana 70602.
Contributions to special assessment for organizing at .20¢ per hour worked.     
Attach separate check made payable to special assessment for organizing along with blue copy of form and mail to 2013 Ryan Street, Lake Charles, Louisiana 70601.
Contributions to international training fund at .10¢ per hour worked.     
Attach separate check made payable to international training fund along with white copy of form and mail to 2013 Ryan Street, Lake Charles, Louisiana 70601.
We certify that the above is a true and complete report of hours worked by journeymen and apprentices and does not include hours worked by any other employees, partners, owners or proprietors of the firm.

BY:


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