MA WEEKLY CERTIFIED PAYROLL FORM PREVAILING WAGE~84.pdf

PDF 759 KB Posted

Attached to
TRD02 Asphalt Paving Loading Dock Removal and Installation of Asphalt Driveway
Solicitation number
BD-27-1022-DMH05-5410A-132170
Issued by
Bristol County, Massachusetts

About this file

Written by GovTribe AI ·

This is a Massachusetts Weekly Certified Payroll Report and Workforce Participation Form required by the Commonwealth of Massachusetts under General Laws Chapter 149, Section 27B for public works projects. The form applies to contractors and subcontractors working on the TRD02 Asphalt Paving Loading Dock Removal and Installation of Asphalt Driveway project in Massachusetts. Contractors and subcontractors are required to submit true and accurate weekly payroll records to the awarding authority by first-class mail or email, accompanied by a signed statement of compliance from the employer. The form requires detailed documentation of employee hours worked by classification, including breakdown by day of the week, with employees identified by demographic category (minority, woman, or non-minority status) and OSHA 10 certification status.

The Commonwealth has established workforce participation goals of 15.3% for minorities and 6.9% for women, which contractors must strive to achieve on the project. The payroll form requires documentation of hourly wages, health and welfare insurance contributions, ERISA pension plan contributions, supplemental unemployment benefits, and total fringe benefit contributions for each employee. Additionally, contractors must certify apprentice employee information, including current registration status with the Massachusetts Department of Labor Standards' Division of Apprentice Standards and submission of apprentice identification cards. Failure to submit compliant certified payroll documentation may result in criminal action or civil citation. The form provides multiple rows for employee entries and requires identification of the general/prime contractor, subcontractors, minimum wage rate sheet reference, contract number, and taxpayer identification number.

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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

Page ______ of ________

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:
Row1_9:
Row1_10:
Row1_11:
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:
Row1_16:
Row1_17:
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:
Row1_19:
Row1_20:
Row1_21:
Row1_22:
Row1_23:
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:
Row1_25:
Row1_26:
Row1_27:
Row1_28:
Row1_29:
Row1_30:
Row2:
Row2_2:
Row2_3:
Row2_4:
Row2_5:
Row2_6:
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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