WRA-3124CERTPAYROLLFORM.pdf
PDF 128 KB Posted
- Solicitation number
- S120234-vCurrent
- Issued by
- Norfolk County, Quincy City, Massachusetts
About this file
This document is a Massachusetts Weekly Certified Payroll Report Form for a public works project. The form includes information about the company, contract, and project details, as well as the work classification, hours, and wages for each employee. The report must be submitted weekly by the contractor and subcontractor to the awarding authority as required under Massachusetts General Law Chapter 149 Section 27B. Failure to comply may result in criminal or civil penalties. The form tracks the employee name, work classification, hours worked each day, hourly base wage, fringe benefit contributions, and total gross wages.
The report provides transparency into the labor costs and compliance with prevailing wage requirements for the public works project. It requires the contractor and subcontractor to attest to the accuracy of the information reported. This document is a critical component of the state and local contract administration and oversight process.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| WRA-3124PREVWAGENOTICE.pdf | ||
| WRA-3124PREVWAGE.pdf | ||
| WRA-3124RFB.pdf | ||
| S120234-vCurrent_OD.xlsx | XLSX spreadsheet | |
| WRA-3124COMPLIANCE.pdf |
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Text version
MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REPORT FORM
Company's Name: Address: Phone No.: Payroll No.:
Employer's Signature: Title: Contract No: Tax Payer ID No. Work Week Ending:
Awarding Authority's Name: Public Works Project Name: Public Works Project Location: Min. Wage Rate Sheet No.
General / Prime Contractor's Name: Subcontractor's Name: "Employer" Hourly Fringe Benefit Contributions
(B+C+D+E) (A x F)
Employee Name & Complete Address
Employee is
OSHA 10
Certified (?) Work Classification:
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)
Pursuant to MGL Ch. 149 s.27B, every contractor and subcontractor is required to submit a "true and accurate" copy of their weekly payroll records directly NOTE:
to the awarding authority. Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.
Date recieved by awarding authority
Page of / /
Hours Worked
Project Gross Wages
(G)
Project Hours
(A)
Draft 2
| Companys Name:, Row 1: |
| Address:, Row 1: |
| Phone No:, Row 1: |
| Payroll No:, Row 1: |
| Employers Signature:, Row 1: |
| Title:, Row 1: |
| Contract No:, Row 1: |
| Tax Payer ID No, Row 1: |
| Work Week Ending:, Row 1: |
| Awarding Authoritys Name:, Row 1: |
| Public Works Project Name:, Row 1: |
| Public Works Project Location:, Row 1: |
| Min Wage Rate Sheet No, Row 1: |
| General Prime Contractors Name:, Row 1: |
| Subcontractors Name:, Row 1: |
| Su, Row 2: |
| Mo, Row 2: |
| Tu, Row 2: |
| We, Row 2: |
| Th, Row 2: |
| Fr, Row 2: |
| Sa, Row 2: |
| Work Classification:, Row 1: |
| Su, Row 1: |
| Mo, Row 1: |
| Tu, Row 1: |
| We, Row 1: |
| Th, Row 1: |
| Fr, Row 1: |
| Sa, Row 1: |
| Work Classification:, Row 2: |
| Su, Row 3: |
| Mo, Row 3: |
| Tu, Row 3: |
| We, Row 3: |
| Th, Row 3: |
| Fr, Row 3: |
| Sa, Row 3: |
| Su, Row 4: |
| Mo, Row 4: |
| Tu, Row 4: |
| We, Row 4: |
| Th, Row 4: |
| Fr, Row 4: |
| Sa, Row 4: |
| Work Classification:, Row 3: |
| Su, Row 5: |
| Mo, Row 5: |
| Tu, Row 5: |
| We, Row 5: |
| Th, Row 5: |
| Fr, Row 5: |
| Sa, Row 5: |
| Su, Row 6: |
| Mo, Row 6: |
| Tu, Row 6: |
| We, Row 6: |
| Th, Row 6: |
| Fr, Row 6: |
| Sa, Row 6: |
| Work Classification:, Row 4: |
| Su, Row 7: |
| Mo, Row 7: |
| Tu, Row 7: |
| We, Row 7: |
| Th, Row 7: |
| Fr, Row 7: |
| Sa, Row 7: |
| Su, Row 8: |
| Mo, Row 8: |
| Tu, Row 8: |
| We, Row 8: |
| Th, Row 8: |
| Fr, Row 8: |
| Sa, Row 8: |
| Work Classification:, Row 5: |
| Su, Row 9: |
| Mo, Row 9: |
| Tu, Row 9: |
| We, Row 9: |
| Th, Row 9: |
| Fr, Row 9: |
| Sa, Row 9: |
| Su, Row 10: |
| Mo, Row 10: |
| Tu, Row 10: |
| We, Row 10: |
| Th, Row 10: |
| Fr, Row 10: |
| Sa, Row 10: |
| Work Classification:, Row 6: |
| Su, Row 11: |
| Mo, Row 11: |
| Tu, Row 11: |
| We, Row 11: |
| Th, Row 11: |
| Fr, Row 11: |
| Sa, Row 11: |
| Su, Row 12: |
| Mo, Row 12: |
| Tu, Row 12: |
| We, Row 12: |
| Th, Row 12: |
| Fr, Row 12: |
| Sa, Row 12: |
| Work Classification:, Row 7: |
| Su, Row 13: |
| Mo, Row 13: |
| Tu, Row 13: |
| We, Row 13: |
| Th, Row 13: |
| Fr, Row 13: |
| Sa, Row 13: |
| Su, Row 14: |
| Mo, Row 14: |
| Tu, Row 14: |
| We, Row 14: |
| Th, Row 14: |
| Fr, Row 14: |
| Sa, Row 14: |
| Date recieved by awarding authority: |
| Apprentice Rate - Row 4: |
| Apprentice Rate - Row 5: |
| Apprentice Rate - Row 6: |
| Apprentice Rate - Row 7: |
| C3: |
| C2: |
| D7: |
| D6: |
| D5: |
| D4: |
| D3: |
| D2: |
| D1: |
| B2: |
| B3: |
| B4: |
| B5: |
| B6: |
| B7: |
| H7: |
| H6: |
| H5: |
| H4: |
| H3: |
| H2: |
| H1: |
| A1 - Project Hours, Row 1: |
| A2 - Project Hours, Row 2: |
| A3 - Project Hours, Row 3: |
| A4 - Project Hours, Row 4: |
| A5 - Project Hours, Row 5: |
| A6 - Project Hours, Row 6: |
| A7 - Project Hours, Row 7: |
| All Other Hours, Row 1: |
| All Other Hours, Row 2: |
| All Other Hours, Row 3: |
| All Other Hours, Row 4: |
| All Other Hours, Row 5: |
| All Other Hours, Row 6: |
| All Other Hours, Row 7: |
| G1 - Project Gross Wages, Row 1: |
| G2 - Project Gross Wages, Row 2: |
| G3 - Project Gross Wages, Row 3: |
| G4 - Project Gross Wages, Row 4: |
| G5 - Project Gross Wages, Row 5: |
| G6 - Project Gross Wages, Row 6: |
| G7 - Project Gross Wages, Row 7: |
| Total Gross Wages, Row 1: |
| Total Gross Wages, Row 2: |
| Total Gross Wages, Row 3: |
| Total Gross Wages, Row 4: |
| Total Gross Wages, Row 5: |
| Total Gross Wages, Row 6: |
| Total Gross Wages, Row 7: |
| Employee Name & Complete Address, Row 3: |
| Employee Name & Complete Address, Row 2: |
| Employee Name & Complete Address, Row 1: |
| Employee Name & Complete Address, Row 4: |
| Employee Name & Complete Address, Row 7: |
| Employee Name & Complete Address, Row 6: |
| Employee Name & Complete Address, Row 5: |
| Apprentice Rate - Row 1: |
| Apprentice Rate - Row 2: |
| Apprentice Rate - Row 3: |
| B1: |
| C1: |
| E1: |
| C4: |
| C6: |
| E2: |
| E4: |
| E5: |
| E6: |
| E7: |
| F1: |
| F2: |
| F3: |
| F4: |
| F5: |
| F6: |
| F7: |
| E3: |
| C7: |
| Check Box205: Off |
| Check Box206: Off |
| Check Box207: Off |
| Check Box208: Off |
| Check Box209: Off |
| Check Box210: Off |
| Check Box211: Off |
| C5: |
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