CM-16_-_Wage_Theft_Form.pdf

WAGE THEFT PREVENTION

Published May 2025

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The City of Boston has established requirements for City contracts in an effort to prevent wage theft.

Prospective vendors must provide the following certifications or disclosures with their bids/proposals. Failure to provide the following shall result in rejection of the bid/proposal.

INSTRUCTIONS

A vendor must check box 1 or box 2 as applicable and must sign this form, certifying compliance with the requirements set out in this Form. This form must be included with the bid or proposal, and for multi-year contracts must be completed annually on the contract anniversary.

Pursuant to the above mentioned Executive Order, vendors who have been awarded a contract with the City of Boston must post the Massachusetts Wage and Hour Laws notice informing employees of the protections of G.L. c. 149, c. 151, and the Fair Labor Standards Act in conspicuous places.

This notice can be found at: mass.gov/ago/docs/workplace/wage/wagehourposter.pdf

CERTIFICATION

The undersigned certifies under penalties of perjury that the vendor is in compliance with the provisions of the Executive Order titled “Establishing Requirements for City Contracts in an Effort to Prevent Wage Theft,” as currently in effect.

1 Neither this firm nor any subcontractor has been subject to a federal or state criminal or civil judgment, administrative citation, final administrative determination, order or debarment resulting from a violation of G.L. c149, c151, or the Fair Labor Standards Act within three

(3) years prior to the date of this bid/proposal submission.

Select one statement to certify, as applicable.

2 This firm, or a subcontractor of this firm, has been subject to a federal or state criminal or civil judgment, administrative citation, final administrative determination, order or debarment resulting from a violation of G.L. c149, c151, or the Fair Labor Standards Act within three

(3) years prior to the date of this bid/proposal submission and such documentation is included in the bid/proposal submission.

3 Any federal or state criminal or civil judgment, administrative citation, final administrative determination, order or debarment resulting from a violation of G.L. c149, c151, or the Fair Labor Standards Act imposed while any bid/proposal is pending and, if awarded a contract, during the term of the contract, will be reported to the Official within five (5) days of receiving notice.

All vendors must certify.

WAGE THEFT PREVENTION

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4 Vendors awarded a contract that have disclosed a federal or state criminal or civil judgment, administrative citation, final administrative determination, or order resulting from a violation of G.L. c149, c151, or the Fair Labor Standards Act within three (3) years prior to the date of this bid/proposal, or during the term of the contract and through the contract term shall furnish their monthly certified payrolls to the Official for all employees working on such contract and may be required to obtain a wage bond or other suitable insurance in an amount equal to the aggregate of one year’s gross wages for all employees. Vendors subject to a state or federal debarment for violation of the above laws or prohibited from contracting with the Commonwealth are prohibited from contracting with the City, and upon a finding or order of debarment or prohibition, the City may terminate the contract.

All vendors must certify.

5 Notice provided by the City, informing employees of the protections of the Order and applicable local, state, and federal law will be posted in conspicuous places.

Name of person signing quotation, bid, or proposal

Name of Business

Signature

Date

APPROVED AS TO FORM BY CORPORATION COUNSEL APRIL, 2025