Prevailing Wage Payroll Report Form~47.pdf

PDF 87 KB Posted Aug 12, 2022

Attached to: DRM 2018-46 #8 Conduit Installation @ NECC
Solicitation number: BD-23-1025-DOCFS-9821-78375
Issued by: Middlesex County, Massachusetts

About this file

Written by GovTribe AI · Aug 1, 2024

This document is a Massachusetts Weekly Certified Payroll Report Form for a public works construction project. The form requires contractors and subcontractors to submit certified weekly payroll records, including employee names, work classifications, hours worked, wage rates, and fringe benefit contributions, to the awarding authority. The report must be accompanied by a statement of compliance signed by the employer. Failure to comply may result in criminal or civil penalties.

The related state and local contract opportunity is for conduit installation at the Northeast Correctional Center in Massachusetts. The bid documents will be available by appointment starting August 18, 2022, and bid intent forms are due by August 26, 2022. No other details about the project scope, timeline, or other requirements are provided in the information given.

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Plan Holders List~21.docx	DOCX document	Aug 12, 2022
Bid_Intent_Form~2.doc	DOC document	Aug 12, 2022
Bid Results~47.doc	DOC document	Aug 12, 2022
Bid Package~10.doc	DOC document	Aug 12, 2022
Site Visit Attendees~5.pdf	PDF	Aug 12, 2022
SDP Plan Form 3~5.xlsx	XLSX spreadsheet	Aug 12, 2022
Bidder Checklist~39.doc	DOC document	Aug 12, 2022
DRM 2018-46 8 Conduit Installation - NECC - Addendum 1.pdf	PDF	Aug 12, 2022
Prevailing Wages~19.pdf	PDF	Aug 12, 2022
Where to get plans and specs~22.docx	DOCX document	Aug 12, 2022
Prevailing Wage Statement of Compliance~47.pdf	PDF	Aug 12, 2022

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MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REPORT FORM

Company's Name: Address: Phone No.: Payroll No.:

Employer's Signature: Title: Contract No: Tax Payer ID Number Work Week Ending:

Awarding Authority's Name: Public Works Project Name: Public Works Project Location: Min. 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 & Complete Address

Work Classification:

Employee is OSHA certified

Appr.

Rate (%) Su. Mo. Tu. We. Th. Fr. Sa.

All Other Hours

Hourly Base Wage

(B)

Health & Welfare

Insurance (C)

ERISA

Pension

Plan (D)

Supp.

Unemp.

(E)

Total Hourly

Prev. Wage (F)

Total Gross Wages

Check No.

(H)

Are all apprentice employees identified above currently registered with the MA DLS's Division of Apprentice Standards? YES NO

No apprentices are identified above

Date Received by Awarding Authority

Page ________of________ / /

NOTE: 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 e-mail. 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.

For all apprentices performing work during the reporting period, attach a copy of the apprentice identification card issued by the Massachusetts Department of Labor Standards / Division of Apprentice Standards.

Hours Worked Project Gross Wages

Project Hours

(A)

Companys NameRow1:

AddressRow1:

Phone NoRow1:

Payroll NoRow1:

Employers SignatureRow1:

TitleRow1:

Contract NoRow1:

Tax Payer ID NumberRow1:

Work Week EndingRow1:

Awarding Authoritys NameRow1:

Public Works Project NameRow1:

Public Works Project LocationRow1:

Min Wage Rate Sheet NumberRow1:

General Prime Contractors NameRow1:

Subcontractors NameRow1:

undefined_2:

Employee Name Complete AddressRow1:

Work ClassificationRow1:

SuRow1:

MoRow1:

TuRow1:

WeRow1:

ThRow1:

FrRow1:

SaRow1:

All Other Hours Project Hours ARow1:

SuRow2:

MoRow2:

TuRow2:

WeRow2:

ThRow2:

FrRow2:

SaRow2:

All Other Hours Project Hours ARow2:

Hourly Base Wage BRow1:

Total Gross Wages Project Gross WagesRow1:

Health Welfare Insurance CRow1:

ERISA Pension Plan DRow1:

Supp Unemp ERow1:

Total Hourly Prev Wage FRow1:

Total Gross Wages Project Gross WagesRow2:

Check No HRow1:

Employee Name Complete AddressRow2:

Work ClassificationRow2:

undefined_3:

SuRow3:

MoRow3:

TuRow3:

WeRow3:

ThRow3:

FrRow3:

SaRow3:

All Other Hours Project Hours ARow3:

SuRow4:

MoRow4:

TuRow4:

WeRow4:

ThRow4:

FrRow4:

SaRow4:

All Other Hours Project Hours ARow4:

Hourly Base Wage BRow2:

Total Gross Wages Project Gross WagesRow3:

Health Welfare Insurance CRow2:

ERISA Pension Plan DRow2:

Supp Unemp ERow2:

Total Hourly Prev Wage FRow2:

Total Gross Wages Project Gross WagesRow4:

Check No HRow2:

Employee Name Complete AddressRow3:

Work ClassificationRow3:

undefined_4:

SuRow5:

MoRow5:

TuRow5:

WeRow5:

ThRow5:

FrRow5:

SaRow5:

All Other Hours Project Hours ARow5:

SuRow6:

MoRow6:

TuRow6:

WeRow6:

ThRow6:

FrRow6:

SaRow6:

All Other Hours Project Hours ARow6:

Hourly Base Wage BRow3:

Total Gross Wages Project Gross WagesRow5:

Health Welfare Insurance CRow3:

ERISA Pension Plan DRow3:

Supp Unemp ERow3:

Total Hourly Prev Wage FRow3:

Total Gross Wages Project Gross WagesRow6:

Check No HRow3:

Employee Name Complete AddressRow4:

Work ClassificationRow4:

undefined_5:

SuRow7:

MoRow7:

TuRow7:

WeRow7:

ThRow7:

FrRow7:

SaRow7:

All Other Hours Project Hours ARow7:

SuRow8:

MoRow8:

TuRow8:

WeRow8:

ThRow8:

FrRow8:

SaRow8:

All Other Hours Project Hours ARow8:

Hourly Base Wage BRow4:

Total Gross Wages Project Gross WagesRow7:

Health Welfare Insurance CRow4:

ERISA Pension Plan DRow4:

Supp Unemp ERow4:

Total Hourly Prev Wage FRow4:

Total Gross Wages Project Gross WagesRow8:

Check No HRow4:

Employee Name Complete AddressRow5:

Work ClassificationRow5:

undefined_6:

SuRow9:

MoRow9:

TuRow9:

WeRow9:

ThRow9:

FrRow9:

SaRow9:

All Other Hours Project Hours ARow9:

SuRow10:

MoRow10:

TuRow10:

WeRow10:

ThRow10:

FrRow10:

SaRow10:

All Other Hours Project Hours ARow10:

Hourly Base Wage BRow5:

Total Gross Wages Project Gross WagesRow9:

Health Welfare Insurance CRow5:

ERISA Pension Plan DRow5:

Supp Unemp ERow5:

Total Hourly Prev Wage FRow5:

Total Gross Wages Project Gross WagesRow10:

Check No HRow5:

Employee Name Complete AddressRow6:

Work ClassificationRow6:

undefined_7:

SuRow11:

MoRow11:

TuRow11:

WeRow11:

ThRow11:

FrRow11:

SaRow11:

All Other Hours Project Hours ARow11:

SuRow12:

MoRow12:

TuRow12:

WeRow12:

ThRow12:

FrRow12:

SaRow12:

All Other Hours Project Hours ARow12:

Hourly Base Wage BRow6:

Total Gross Wages Project Gross WagesRow11:

Health Welfare Insurance CRow6:

ERISA Pension Plan DRow6:

Supp Unemp ERow6:

Total Hourly Prev Wage FRow6:

Total Gross Wages Project Gross WagesRow12:

Check No HRow6:

Employee Name Complete AddressRow7:

Work ClassificationRow7:

undefined_8:

SuRow13:

MoRow13:

TuRow13:

WeRow13:

ThRow13:

FrRow13:

SaRow13:

All Other Hours Project Hours ARow13:

SuRow14:

MoRow14:

TuRow14:

WeRow14:

ThRow14:

FrRow14:

SaRow14:

All Other Hours Project Hours ARow14:

Hourly Base Wage BRow7:

Total Gross Wages Project Gross WagesRow13:

Health Welfare Insurance CRow7:

ERISA Pension Plan DRow7:

Supp Unemp ERow7:

Total Hourly Prev Wage FRow7:

Total Gross Wages Project Gross WagesRow14:

Check No HRow7:

No apprentices are identified above:

commencement of a criminal action or the issuance of a civil citation:

of:

Check Box2: Off

Check Box3: Off

Text4:

Text5:

Text6:

Text7:

Text8:

Text9:

Text10:

Text11:

Text12:

Text13:

File details come from the government source that posted it. Updated Aug 1, 2024.