Attachment_4_-_Form_WH-347_Wage_and_Hour_Division.pdf

U .S

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.dol.gov/w hd/form s/w h347instr.htm

W age and H our D ivision

P ersons are not required to respond to the collection of inform ation unless it displays a currently valid O M

B control num ber.

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N o.: 1235-0008

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01/31/2015

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W hile com pletion of Form W

H -347 is optional, it is m andatory for covered contractors and subcontractors perform ing w ork on Federally financed or assisted construction contracts to respond to the inform ation collection contained in 29 C

.F.R . §§ 3.3, 5.5(a). The C opeland A ct

(40 U .S

.C . § 3145) contractors and subcontractors perform ing w ork on Federally financed or assisted construction contracts to "furnish w eekly a statem ent w ith respect to the w ages paid each em ployee during the preceding w eek." U

.S . D epartm ent of Labor (D

O L) regulations at

29 C .F.R

. § 5.5(a)(3)(ii) require contractors to subm it w eekly a copy of all payrolls to the Federal agency contracting for or financing the construction project, accom panied by a signed "S tatem ent of C om pliance" indicating that the payrolls are correct and com plete and that each laborer or m echanic has been paid not less than the proper D avis-B acon prevailing w age rate for the w ork perform

ed. D

O L and federal contracting agencies receiving this inform ation review the inform ation to determ ine that em ployees have received legally required w ages and fringe benefits.

Public B urden Statem ent

W e estim ate that is w ill take an average of 55 m inutes to com plete this collection, including tim e for review ing instructions, searching existing data sources, gathering and m aintaining the data needed, and com pleting and review ing the collection of inform ation. If you have any com m ents regarding these estim ates or any other aspect of this collection, including suggestions for reducing this burden, send them to the A dm inistrator, W age and H our D ivision, U

.S . D epartm ent of Labor, R oom S

3502, 200 C onstitution A venue, N .W

W ashington, D .C

. 20210

(over) nthai nthai nthai ate

I, (N am e of Signatory Party)

(Title) do hereby state:

(1) That I pay or supervise the paym ent of the persons em ployed by o n the (C ontractor or Subcontractor)

; that during the payroll period com m encing on the (Building or W ork) day of

, and ending the day of all persons em ployed on s aid project have been paid the full w eekly w ages earned, that no rebates have been or w ill be m ade either directly or indirectly to or on behalf of said from the full

(C ontractor or Subcontractor) w eekly w ages earned by any person and that no deduc tions have been m ade either directly or indirec tly from the full w ages earned by any person, other than perm issible deductions as defined in R egulations, P art

3 (29 C .F.R

. S ubtitle A

), issued by the S ecretary of Labor under the C opeland A ct, as am ended (48 S tat. 948, 63 S tart. 108, 72 S tat. 967; 76 S tat. 357; 40 U

.S .C

. § 3145), and described below

(2) That any payrolls otherw ise under this contract required to be s ubm itted for the above period are correct and com plete; that the w age rates for laborers or m echanics contained therein are not less than the applicable w age rates contained in any w age determ ination incorporated into the c ontract; that the classifications set forth therein for each laborer or m echanic conform w ith the w ork he perform ed.

(3) T hat any apprent ices em ployed in t he abov e period are duly registered in a bona f ide apprenticeship program regis tered w ith a S t ate apprenticeship agency recognized by the B ureau of A pprenticeship and Training, U nited S tates D epartm ent of Labor, or if no such recognized agency exists in a S tate, are registered w ith the B ureau of A pprenticeship and Training, U nited S tates D epartm ent of Labor.

(4) That:

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− in addition to the basic hourly w age rates paid to each laborer or m echanic listed in the above referenced payroll, paym ents of fringe bene fits as listed in the contract have been or w ill be m ade to appropria te progra m s for the bene fit of such em ployees, e xcept as noted in section 4(c) below

(b) W H

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− E ach laborer or m echanic listed in the above referenced payroll has been paid, as indicated on the payroll, an am ount not less than the sum of the applicable basic hourly w age rate plus the am ount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below

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