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WEEKLYPAYROLLRECORDSREPORT&

STATEMENTOFCOMPLIANCE



InaccordancewithMassachusettsGeneralLawc.149,§27B,atrueandaccuraterecord

mustbekeptofallpersonsemployedonthepublicworksprojectforwhichtheenclosed

rateshavebeenprovided,APayrollFormhasbeenprintedonthereverseofthispageand

includesallthe

informationrequiredtobekeptbylaw.Everycontractororsubcontractoris

requiredtokeeptheserecordsandpreservethemforaperiodofthreeyearsfromthedate

ofcompletionofthecontract.

Inaddition,everycontractorandsubcontractorisrequiredtosubmit,onaweeklybasis,a

copyofhisorherweeklypayrollrecordstotheawardingauthority.Foreveryweekinwhich

anapprenticeisemployed,aphotocopyoftheapprentice'sidentificationcardmustbe

attachedtothepayrollreport.Oncecollected,theawardingauthorityisalsorequiredto

preservethosereportsforthreeyears.

Inaddition,eachsuchcontractor,subcontractor,orpublicbodyshallfurnishtothe

awardingauthoritydirectly,withinfifteendaysaftercompletionofitsportionofthework,

astatement,executedbythecontractor,subcontractororpublicbodywhosupervisesthe

paymentofwages,inthefollowingform:

__________________________________________________________________________

STATEMENTOFCOMPLIANCE



___________,200____



I_______________________________________________,____________________________________________

(Nameofsignatoryparty)(Title)



IdoherebystatethatIpayorsupervisethepaymentofthepersonsemployedby



____________________________________________onthe______________________________________

(Contractor,subcontractororpublicbody)(Buildingorproject)



.

andthatallmechanicsandapprentices,teamsters,chauffeursandlaborersemployedonsaid

projecthavebeenpaidinaccordancewithwagesdeterminedundertheprovisionsofsections

twenty‐sixandtwenty‐sevenofchapteronehundredandfortynineoftheGeneralLaws. 



Signature___________________________________,Title___________________________



Print_______________________________________________________________________

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