"Massachusetts Weekly Certified Payroll Report Form" - Massachusetts

Massachusetts Weekly Certified Payroll Report Form is a legal document that was released by the Massachusetts Department of Labor Standards - a government authority operating within Massachusetts.

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Download "Massachusetts Weekly Certified Payroll Report Form" - Massachusetts

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WEEKLY PAYROLL RECORDS REPORT
& STATEMENT OF COMPLIANCE
In accordance with Massachusetts General Law c149, section 27B, a true and
accurate record must be kept of all persons employed on the public works construction
project for which the enclosed rates have been provided. The Weekly Payroll Report
Form includes all the information required to be kept by law. Every contractor or
subcontractor is required to keep these records and preserve them for a period of three
years from the date of completion of the project.
In addition, every contractor and subcontractor is required to submit a copy of
their weekly payroll records to the awarding authority. This is required to be done on a
weekly basis. Once collected, the awarding authority is also required to preserve those
records for three years.
In addition, each such contractor, subcontractor or public body shall furnish to the
Executive Office of Labor within fifteen days after completion of its portion of the work
a statement, executed by the contractor, subcontractor or public body who supervises the
payment of wages, in the following form:
STATEMENT OF COMPLIANCE
Date: _____ / ______ / 20____
I, ________________________________ ,________________________________
(Name of signatory party)
(Title)
do hereby state:
That I pay or supervise the payment of the persons employed by
______________________________ on the _______________________________
(Contractor, subcontractor or public body)
(Building or project)
and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on
said project have been paid in accordance with wages determined under the provisions
of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the
General Laws.
Signature _____________________________
Title _________________________________
WEEKLY PAYROLL RECORDS REPORT
& STATEMENT OF COMPLIANCE
In accordance with Massachusetts General Law c149, section 27B, a true and
accurate record must be kept of all persons employed on the public works construction
project for which the enclosed rates have been provided. The Weekly Payroll Report
Form includes all the information required to be kept by law. Every contractor or
subcontractor is required to keep these records and preserve them for a period of three
years from the date of completion of the project.
In addition, every contractor and subcontractor is required to submit a copy of
their weekly payroll records to the awarding authority. This is required to be done on a
weekly basis. Once collected, the awarding authority is also required to preserve those
records for three years.
In addition, each such contractor, subcontractor or public body shall furnish to the
Executive Office of Labor within fifteen days after completion of its portion of the work
a statement, executed by the contractor, subcontractor or public body who supervises the
payment of wages, in the following form:
STATEMENT OF COMPLIANCE
Date: _____ / ______ / 20____
I, ________________________________ ,________________________________
(Name of signatory party)
(Title)
do hereby state:
That I pay or supervise the payment of the persons employed by
______________________________ on the _______________________________
(Contractor, subcontractor or public body)
(Building or project)
and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on
said project have been paid in accordance with wages determined under the provisions
of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the
General Laws.
Signature _____________________________
Title _________________________________
MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REPORT FORM
Company's Name:
Address:
Phone No.:
Payroll No.:
Employer's Signature:
Title:
Contract No:
Tax Payer ID No.
Work Week Ending:
Awarding Authority's Name:
Public Works Project Name:
Public Works Project Location:
Min. Wage Rate Sheet No.
General / Prime Contractor's Name:
Subcontractor's Name:
"Employer" Hourly Fringe Benefit Contributions
(B+C+D+E)
(A x F)
Project
Project Gross
Hours
Health &
Wages
Hours
Worked
(G)
Employee is
Appr.
(A)
Hourly Base
Welfare
ERISA
Supp.
Total Hourly
OSHA 10
Rate
Wage
Insurance
Pension Plan
Unemp.
Prev. Wage
Check No.
All Other
Total Gross
Employee Name & Complete Address
Certified (?)
Work Classification:
(%)
Su.
Mo.
Tu.
We.
Th.
Fr.
Sa.
(B)
(C')
(D)
(E)
(F)
(H)
Hours
Wages
NOTE:
Pursuant to MGL Ch. 149 s.27B, every contractor and subcontractor is required to submit a "true and accurate" copy of their weekly payroll records directly
to the awarding authority. Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.
Date recieved by awarding authority
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