MA WEEKLY CERTIFIED PAYROLL FORM PREVAILING WAGE~57.pdf

759 KB Posted

Attached to
TRD01 Replace Walk-In Cooler Refrigeration System
Solicitation number
BD-27-1022-DMH05-5430A-131298
Issued by
Massachusetts

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Written by GovTribe AI ·

This is a Massachusetts Weekly Certified Payroll Form for Prevailing Wage compliance, applicable to the TRD01 Replace Walk-In Cooler Refrigeration System project in Massachusetts. The form is used to document and certify that workers employed on prevailing wage projects are paid in accordance with Massachusetts prevailing wage requirements. The form requires weekly reporting and certification of employee payroll data, including worker classifications, hours worked, and wage rates paid. Project managers and contractors must complete and submit this form on a weekly basis throughout the duration of the refrigeration system replacement project to maintain compliance with prevailing wage regulations.

The form serves as the official documentation mechanism for verifying that all workers on the project receive prevailing wages as mandated by Massachusetts law. Contractors are required to certify the accuracy of payroll information and ensure that wage rates meet or exceed the established prevailing wage scale for the specific trade classifications involved in the refrigeration system work. This weekly certification requirement applies to all employees, including laborers, mechanics, and other tradespeople working on the walk-in cooler refrigeration system replacement. Failure to properly complete and submit the certified payroll form can result in non-compliance penalties and may affect contract performance ratings and future bidding eligibility.

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PWS 20260710120124.pdf PDF
SDO SBPP Bid language required 4.28.2022~92.docx DOCX document
PREVAILING WAGE WEEKLY STATEMENT OF COMPLIANCE MA~58.pdf PDF
OSD Bid Form TRD01 FY27 Replace Walk-In Cooler Refrigeration System.docx DOCX document
SOW TRD01 FY27 Replace Walk-In cooler refrigeration system.docx DOCX document

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Massachusetts Weekly Certified Payroll Report and Workforce Participation Form Certified Payroll Report: Pursuant to MGL c. 149, s. 27B, every contractor and subcontractor is required to submit a true and accurate copy of their certified weekly payroll records to the awarding authority by first-class mail or email. In addition, each weekly payroll must be accompanied by a statement of compliance signed by the employer. Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.

Workforce Participation Goals: The Commonwealth of Massachusetts has set the following goals for workforce participation for minorities and women. The participation goals for this project shall be 15.3% for minorities and 6.9% for women. The Contractor shall strive to achieve on this project the labor workforce participation goals contained herein. The Contractor shall enter the number of hours worked in each trade by each employee, identified as woman, minority, or non-minority below.

Company name: Address: Phone number: Payroll number:

Employer’s signature: Job title: Contract Number:

Taxpayer ID Number:

Work week ending:

Awarding Authority name: Public Works project name: Public Works Project Location: Minimum Wage Rate Sheet number:

General/Prime Contractor’s name: Subcontractor’s name: Employer hourly fringe benefit contributions

(B+C+D+E) (A x F) Employee name and Complete address

Work classification

Project hours Non-

Minority

Project hours

Minority

Project hours

Women

Employee is

OSHA 10

certified (?)

Approximate Rate

Percentage

Hours worked Project hours

(A)

Hourly base wage (B)

Health and Welfare

Insurance (C/)

ERISA

Pension Plan (D)

Supplemental unemployment

(E/)

Total Hourly

Previous Wage (F)

Project gross wages

Check number

(H)

S u n d a y

Mon. Tues. Wed. Thur. Fri. Sat. All other hours

Total gross wages

Apprenticeship Documentation: Please answer the questions below.

1. Are any apprentice employees identified above? Yes No

2. If yes, are all apprentice employees identified above currently registered with the Massachusetts Department of Labor Standards’ (DLS), Division of Apprentice Standards (DAS)? Yes No

3. If yes, is a copy of the apprentice Identification (ID) card issued by the MA Department of Labor Standards’ (DLS), Division of Apprentice Standards (DAS) included for all apprentice employees identified above? Yes No

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Company nameRow1:
AddressRow1:
Phone numberRow1:
Payroll numberRow1:
Employers signatureRow1:
Job titleRow1:
Contract NumberRow1:
Taxpayer ID NumberRow1:
Work week endingRow1:
Awarding Authority nameRow1:
Public Works project nameRow1:
Public Works Project LocationRow1:
Minimum Wage Rate Sheet numberRow1:
GeneralPrime Contractors nameRow1:
Subcontractors nameRow1:
Employee name and Complete addressRow1:
Work classificationRow1:
undefined_2:
Employee is OSHA 10 certified Row1:
Approximate Rate Percentage Row1:
TuesRow1:
SatRow1:
All other hoursRow1:
Total gross wagesRow1:
undefined_4:
Total Hourly Previous Wage FRow2:
Total gross wagesRow2:
Check number HRow2:
Employee name and Complete addressRow2:
Work classificationRow2:
undefined_5:
Employee is OSHA 10 certified Row2:
Approximate Rate Percentage Row2:
Row1_3:
Total gross wagesRow3:
Hourly base wage BRow3:
Total Hourly Previous Wage FRow3:
Total gross wagesRow4:
Check number HRow3:
Employee name and Complete addressRow3:
Work classificationRow3:
Employee is OSHA 10 certified Row3:
Approximate Rate Percentage Row3:
Row1_6:
Row1_7:
undefined_9:
Total gross wages:
Hourly base wage BRow4:
Total Hourly Previous Wage F:
Total gross wages_2:
Check number HRow4:
Employee name and Complete addressRow4:
Work classificationRow4:
undefined_10:
Employee is OSHA 10 certified Row4:
Approximate Rate Percentage Row4:
Row1_8:
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Total gross wagesRow7:
Hourly base wage BRow5:
Total Hourly Previous Wage FRow5:
Total gross wagesRow8:
Check number HRow5:
Employee name and Complete addressRow5:
Work classificationRow5:
undefined_12:
Employee is OSHA 10 certified Row5:
Approximate Rate Percentage Row5:
Row1_12:
Row1_15:
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undefined_13:
Total gross wages_3:
Hourly base wage BRow6:
Total Hourly Previous Wage F_2:
Total gross wages_4:
Check number HRow6:
Employee name and Complete addressRow6:
Work classificationRow6:
Employee is OSHA 10 certified Row6:
Approximate Rate Percentage Row6:
Row1_18:
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undefined_14:
Total gross wages_5:
Hourly base wage BRow7:
Total Hourly Previous Wage F_3:
Total gross wages_6:
Check number HRow7:
Employee name and Complete addressRow7:
Work classificationRow7:
Employee is OSHA 10 certified Row7:
Approximate Rate Percentage Row7:
Row1_24:
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undefined_15:
Total gross wages_7:
Hourly base wage BRow8:
Total Hourly Previous Wage F_4:
Total gross wages_8:
Check number HRow8:
Are any apprentice employees identified above Yes: Off
No: Off
If yes are all apprentice employees identified above currently registered with the Massachusetts Department of Labor Standards DLS Division of Apprentice Standards DAS Yes: Off
No_2: Off
If yes is a copy of the apprentice Identification ID card issued by the MA Department of Labor Standards DLS Division of Apprentice Standards DAS included for all apprentice employees identified:
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Check Box177: Off

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